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

Copyright © 2009 EDIZIONI MINERVA MEDICA

language: English

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


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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.

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