Septal myectomy in hypertrophic obstructive cardiomyopathy: late results with stress echocardiography.
BACKGROUND
This study was performed to assess the functional capacity of the survivors of septal myectomy for the treatment of hypertrophic obstructive cardiomyopathy in long-term follow-up as assessed by dobutamine stress echocardiography.


METHODS
Sixty-nine patients with hypertrophic obstructive cardiomyopathy underwent septal myectomy between 1975 and 1996. The mean age was 25.4 +/- 13.6 years (range, 6-58 years), and 10 of the patients were women. The early mortality was 4.3%. Hospital survivors (95.7%) were followed up for a mean of 43.8 +/- 28.7 months (range, 6-114 months).


RESULTS
The postoperative mean functional capacity of the group was 1.47 +/- 0.56. No late deaths were reported. Forty-nine patients (74.2%) were evaluated with standard echocardiographic techniques, and 29 (43.9%) patients underwent dobutamine stress echocardiography. There was a significant decrease in the thickness of the interventricular septum after surgery. The mean preoperative and postoperative septal thickness was 1.99 +/- 0.59 cm (range, 1.3-3.8 cm) and 1.55 +/- 0.41 cm (range, 0.96-2.8 cm), respectively (p < 0.004). The mean posterior wall thickness was significantly less than the preoperative value (p = 0.008) and the left ventricular end-diastolic diameter was slightly greater in the postoperative measurements, but the difference was not significant (p = 0.162). Postoperative left ventricular outflow systolic gradients were reduced significantly when compared with preoperative values (preoperative mean, 78.4 +/- 33.6 mm Hg, range, 50-212 mm Hg versus postoperative mean, 17.9 +/- 15.9 mm Hg: range, 0-40 mm Hg; p < 0.0001).


CONCLUSIONS
Septal myectomy for patients with hypertrophic obstructive cardiomyopathy is a safe procedure with excellent clinical and functional results in the long-term follow-up.
Göl
M K
MK
Cardiovascular Surgery Clinic, Türkiye Yüksek Ihtisas Hospital, Ankara, Turkey. hk04-k@servis.net.tr
Emir
M
M
Keleş
T
T
Küçüker
S A
SA
Birincioğlu
C L
CL
Karagöz
Y H
YH
Kural
T
T
Taşdemir
O
O
Göksel
S
S
Bayazit
K
K
D000206:Actuarial Analysis; D000293:Adolescent; D000318:Adrenergic beta-Agonists; D000328:Adult; D001021:Aortic Valve / Q000002:abnormalities / Q000601:surgery; D002312:Cardiomyopathy, Hypertrophic / Q000000981:diagnostic imaging / Q000503:physiopathology / Q000601:surgery*; D002648:Child; D004280:Dobutamine; D004452:Echocardiography; D015150:Echocardiography, Doppler; D005260:Female; D005500:Follow-Up Studies; D006321:Heart / Q000503:physiopathology; D006346:Heart Septum / Q000000981:diagnostic imaging / Q000601:surgery*; D006352:Heart Ventricles / Q000000981:diagnostic imaging / Q000601:surgery; D006801:Humans; D008137:Longitudinal Studies; D008297:Male; D008875:Middle Aged; D008943:Mitral Valve / Q000601:surgery; D012449:Safety; D013318:Stroke Volume; D015996:Survival Rate; D013599:Systole; D016277:Ventricular Function, Left; D014694:Ventricular Outflow Obstruction / Q000601:surgery
D000318:Adrenergic beta-Agonists; D004280:Dobutamine