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CURRENT ISSUETHE JOURNAL OF CARDIOVASCULAR SURGERY

A Journal on Cardiac, Vascular and Thoracic Surgery

Indexed/Abstracted in: BIOSIS Previews, Current Contents/Clinical Medicine, EMBASE, PubMed/MEDLINE, Science Citation Index Expanded (SciSearch), Scopus
Impact Factor 1,632

Frequency: Bi-Monthly

ISSN 0021-9509

Online ISSN 1827-191X

 

The Journal of Cardiovascular Surgery 2000 February;41(1):53-6

CARDIAC PAPERS 

    CASE REPORTS

Mitral valve repair and septal myectomy for hypertrophic obstructive cardiomyopathy

Matsui Y., Shiiya N., Murashita T., Sasaki S., Yasuda K.

From the Depart­ment of Car­di­o­vas­cular Sur­gery Hok­kaido Uni­ver­sity, Sap­poro, ­Japan

Com­bined ­mitral ­valve ­repair ­using the ­sliding ­leaflet tech­nique and ­septal myec­tomy ­were ­employed to suc­cess­fully ­treat ­left ven­tric­ular out­flow ­tract (­LVOT) obstruc­tion and ­mitral regur­gi­ta­tion due to hyper­trophic obstruc­tive car­di­om­yo­pathy (­HOCM). A 46-­year-old man was diag­nosed ­with ­HOCM ­along ­with con­ges­tive ­heart ­failure and was ­treated med­i­cally. ­These symp­toms, how­ever, ­were ­resistant to med­ical treat­ments ­with a ­beta-­blocker, a Ca-antag­o­nist, and dis­opy­ra­mide, and he was ­referred to our hos­pital for sur­gery. Dop­pler ech­o­car­di­og­raphy dem­on­strated an ­LVOT obstruc­tion at ­rest ­with a ­peak pres­sure gra­dient of 138 ­mmHg. The inter­ven­tric­ular ­septum thick­ness was 14 mm. ­Mitral regur­gi­ta­tion of 3+ ­with ­severe SAM was ­also ­observed. Tem­po­rary ­dual ­chamber ­pacing was ­tried ­without sig­nif­i­cant improve­ment. Fol­lowing ­these exam­ina­tions, the ­patient under­went sur­gery. A trans­aortic ­septal myo­tomy-myec­tomy was per­formed ­first, and the ­mitral ­valve was ­then ­approached ­through the ­left ­atrium. ­Mitral ­valve ­repair was per­formed ­with the ­sliding ­leaflet tech­nique to ­reduce the ­height of the pos­te­rior ­leaflet ­from 2 cm to 1 cm. Post­pump tran­se­soph­a­geal ech­o­car­di­og­raphy ­revealed no MR and a ­peak ­LVOT gra­dient of 15 ­mmHg. The ­patient recov­ered ­well ­except for a ­residual ­mild SAM, and MR2+. We there­fore con­cluded ­that ­this sur­gical ­approach ­might pro­vide ­results ­which are ­superior to ­those of myec­tomy ­alone.

language: English


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