[Obstructive hypertrophic cardiomyopathy: medical or surgical treatment?].
This retrospective study assesses the results of medical and surgical treatment on survival and functional capacity of patients with hypertrophic obstructive cardiomyopathy (HOCM). Between 1981 and 1991, 73 patients were referred for treatment of HOCM: 24 were operated (Group 1) and 49 were treated medically (Group 2). Patients in Group 1 had more severe forms of HOCM than those in Group 2: 83% were in > or = NYHA Class III compared with only 20% in Group 2 (p = 0.003); 42% had previous cardiac failure compared with 16% in Group 2 (p = 0.02); 29% had atrial fibrillation compared with only 8% in Group 2 (p = 0.004); the average intraventricular pressure gradient was 78 mmHg compared with 42 mmHg in Group 2 (p = 0.001); mean pulmonary arterial pressures were 24 mmHg compared with 15 mmHg in Group 2 (p < 0.001); the cardiac index was 2.2 l/min/m2 compared with 2.7 l/min/m2 in Group 2 (p = 0.001); Sellers > or = grade 3 mitral regurgitation was present in 48% compared with 12% in Group 2 (p = 0.002). However, a family history of HOCM or of sudden death was commoner in Group 2 (28% vs 4% in Group 1: p = 0.03). Surgery consisted of myomectomy alone (5 patients) or associated with mitral valve replacement (MVR) (17 patients) or MVR alone (2 patients). Two patients in Group 1 died (1 perioperative death, 1 late death due to dissection of the aorta), giving over a 3.4 +/- 3.0 year follow-up period without any losses to follow-up, an abnormal mortality of 2.4%.(ABSTRACT TRUNCATED AT 250 WORDS)
Azzano
O
O
Hôpital cardiologique, BP Lyon-Montchat.
Garé
J P
JP
de Gevigney
G
G
Milon
H
H
Mikaeloff
P
P
Delahaye
J P
JP
D000206:Actuarial Analysis; D000328:Adult; D000368:Aged; D002312:Cardiomyopathy, Hypertrophic / Q000401:mortality / Q000628:therapy*; D005260:Female; D005500:Follow-Up Studies; D006350:Heart Valve Prosthesis; D006801:Humans; D008297:Male; D008875:Middle Aged; D008944:Mitral Valve Insufficiency / Q000601:surgery; D011379:Prognosis; D012189:Retrospective Studies; D016019:Survival Analysis
Myocardiopathie hypertrophique obstructive: traitement médical ou chirurgical?