Key result
Discrete subaortic membranes in HCM cause outflow obstruction best managed with surgical myectomy over alcohol ablation.
Why the study?
Subaortic obstruction in HCM is typically attributed to SAM with septal contact, but discrete subaortic membranes causing obstruction are underrecognized and have distinct management implications.
Observational
Subaortic obstruction due to systolic anterior motion (SAM) of the mitral valve with ventricular septal contact is a major cause of progressive heart failure symptoms in patients with hypertrophic cardiomyopathy (HCM). However, we have recently observed a unique, but not uncommon subgroup of HCM patients with outflow tract obstruction due only to discrete subaortic membrane or who have a membrane in addition to SAM-septal contact. HCM patients with subaortic membranes may be at increased risk for developing progressive heart failure symptoms. Identification requires a high index of suspicion and raises important management considerations, including need for surgical myectomy for definitive relief of obstruction with associated excellent outcomes, as the alternative invasive treatment option with percutaneous alcohol septal ablation would be ineffective.
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Kannappan et al. (2017) conducted an observational in Hypertrophic cardiomyopathy with left ventricular outflow obstruction. Discrete subaortic membranes was evaluated. Discrete subaortic membranes in hypertrophic cardiomyopathy represent an underappreciated cause of outflow obstruction that requires surgical myectomy rather than percutaneous alcohol septal ablation.
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