[Surgical treatment for hypertrophic obstructive cardiomyopathy].
OBJECTIVE
Five percent of the patients with hypertrophic obstructive cardiomyopathy (HOCM) have symptoms unresponsive to medical treatment and are candidates for invasive therapy. The objective of this study was to analyze our results with surgical treatment of HOCM during the last 10 years.


METHODS
Between July 1993 and January 2004 26 patients with HOCM refractory to drug therapy were operated on. An extended septal myectomy was performed, in combination with anterior mitral leaflet plication in 19 cases (73%) and with mitral valve replacement in 5 (19%). Evolution of the grade of dyspnea, left ventricle outflow tract gradient (LVOTG), mitral regurgitation, and systolic anterior motion after surgery was analyzed.


RESULTS
Mean follow-up was 63 (37) months. After surgery, a significant reduction in LVOTG (from 96.5 to 19.5 mmHg; P<.001), grade of mitral regurgitation (from 2.54 to 0.69; P<.001) and systolic anterior motion (from 2.92 to 0.23; P<.001) was achieved, which led to improvement in functional class. Hospital mortality and need for pacemaker implantation due to complete heart block after surgery was 3.8% (n=1). There were no cases of iatrogenic ventricular septal defect or mitro-aortic valve injury. Actuarial survival at 5 years was 96% (4%).


CONCLUSIONS
Surgery in patients with HOCM yields great clinical improvements with low morbidity and mortality. Simultaneous intervention for both myocardial and valvular components of the disease allows not only reduction in the LVOTG but also correction of mitral regurgitation and abolition of systolic anterior motion.
Castedo
Evaristo
E
Departamento de Cirugía Cardiovascular, Clínica Puerta de Hierro, Madrid, Spain. evaristocm@terra.es
Cabo
Rubén A
RA
Núñez
Iván
I
Monguió
Emilio
E
Montero
Carlos G
CG
Burgos
Raúl
R
Serrano-Fiz
Santiago
S
Téllez
Gabriel
G
González
Magdalena
M
Cavero
Miguel A
MA
Ugarte
Juan
J
D000328:Adult; D000368:Aged; D006348:Cardiac Surgical Procedures / Q000379:methods; D002312:Cardiomyopathy, Hypertrophic / Q000175:diagnosis / Q000503:physiopathology / Q000601:surgery*; D005260:Female; D005500:Follow-Up Studies; D006346:Heart Septum / Q000601:surgery*; D006801:Humans; D008297:Male; D008875:Middle Aged; D008943:Mitral Valve / Q000473:pathology / Q000601:surgery; D014694:Ventricular Outflow Obstruction / Q000503:physiopathology