Surgical treatment versus medical treatment in hypertrophic obstructive cardiomyopathy.
Sixty-three patients operated upon for HOCM and 49 patients selected for non-surgical treatment have been followed-up for 15 years. Pre-operatively, surgical patients had a higher left ventricular outflow tract gradient at rest and, on the average, more severe symptoms than non-surgical patients. Septal myectomy relieved the pressure gradient and symptoms more consistently than long-term treatment with beta-blockers or verapamil. Within an average observation time of 7 1/2 years, there was late deterioration or death in almost half of the non-surgical patients but in less than one-quarter in the operated patients. The 10 year mortality rate was 80% in the surgical series and 71% in the non-surgical series. In operated patients, pre-operative symptomatic status was significantly related to early and late mortality. In medically treated patients, mortality was unrelated to symptoms; however, it was significantly lower in patients receiving long term treatment with beta-blockers or verapamil. In conclusion, a high basal pressure gradient associated to limiting symptoms is a clear-cut indication for surgery. Other indications are more debatable. In medically treated patients, long-term administration of beta-blockers or verapamil is beneficial even without symptoms as it appears to improve prognosis.
D000293:Adolescent; D000328:Adult; D002312:Cardiomyopathy, Hypertrophic / Q000401:mortality / Q000628:therapy*; D005260:Female; D005500:Follow-Up Studies; D006346:Heart Septum / Q000601:surgery; D006801:Humans; D008297:Male; D008875:Middle Aged; D011433:Propranolol / Q000627:therapeutic use; D013997:Time Factors; D014700:Verapamil / Q000627:therapeutic use
D011433:Propranolol; D014700:Verapamil