Original articleAdult cardiacMitral Valve Abnormalities in Hypertrophic Cardiomyopathy: Echocardiographic Features and Surgical Outcomes
Section snippets
Patients
From January 1986 to January 2003, 851 symptomatic patients underwent operation for HCM at The Cleveland Clinic. These 851 were established after personal review (B.W.L., N.G.S.) of all patients undergoing operation for HCM for any reason during this period, using consensus criteria [8]. Of these, 115 (14%) underwent a concomitant MV procedure, with 102 undergoing a concomitant septal myectomy, leaving 13 patients with HOCM who underwent MV replacement alone. Valve repairs were done in 67
Morphologic Features
Echocardiography documented restrictive leaflet abnormalities in 80 patients and elongated leaflets in 64 (Table 2). Degenerative and myxomatous pathologies were present in 59 (51%). Subvalvar chordal and papillary muscle abnormalities were found in 22 and 23 patients, respectively. Nearly all of the myxomatous valves had severe MR but the lowest LVOT gradients (Table 3); conversely, restricted chordal abnormalities were associated with the least prevalence of severe MR and the highest LVOT
Comment
Mitral valve abnormalities are common in patients with HCM, but their frequency and impact on surgical therapies is poorly defined. Limitations of previously published studies include small cohort size, focus on individual abnormalities, and focus on autopsy series. Our goal was to use echocardiographic analysis and our large experience with surgical therapy for HCM to define the spectrum of MV abnormalities, evaluate how they affect surgical therapies, and investigate durability of modern
References (27)
- et al.
Extended septal myectomy for hypertrophic obstructive cardiomyopathy with anomalous mitral papillary muscles or chordae
J Thorac Cardiovasc Surg
(2004) - et al.
Mitral regurgitation due to ruptured chordae tendineae in patients with hypertrophic obstructive cardiomyopathy
J Am Coll Cardiol
(1992) - et al.
Mitral regurgitation in hypertrophic obstructive cardiomyopathy: relationship to obstruction and relief with myectomy
J Am Coll Cardiol
(2000) - et al.
A report of the American College of Cardiology Foundation Task Force on Clinical Expert Consensus Documents and the European Society of Cardiology Committee for Practice Guidelines
J Am Coll Cardiol
(2003) - et al.
ASE/SCA guidelines for performing a comprehensive intraoperative multiplane transesophageal echocardiography examination: recommendations of the American Society of Echocardiography Council for Intraoperative Echocardiography and the Society of Cardiovascular Anesthesiologists Task Force for Certification in Perioperative Transesophageal Echocardiography
J Am Soc Echocardiogr
(1999) - et al.
Doppler echocardiographic determination of the pressure gradient in hypertrophic cardiomyopathy
J Am Coll Cardiol
(1988) - et al.
Intraoperative Doppler echocardiography in hypertrophic cardiomyopathy: correlations with the obstructive gradient
J Am Coll Cardiol
(1987) Breaking down barriers: helpful breakthrough statistical methods you need to understand better
J Thorac Cardiovasc Surg
(2001)Cardiac valve surgery—the “French correction.”
J Thorac Cardiovasc Surg
(1983)- et al.
Durability of mitral valve repair for degenerative disease
J Thorac Cardiovasc Surg
(1998)
Hypertrophic cardiomyopathy is predominantly a disease of left ventricular outflow tract obstruction
Circulation
Muscular subvalvular aortic stenosisAbnormal anterior mitral leaflet possibly the primary factor
Acta Radiol Diagn (Stockh)
Anomalous insertion of papillary muscle directly into anterior mitral leaflet in hypertrophic cardiomyopathySignificance in producing left ventricular outflow obstruction
Circulation
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