title: Mitral valve abnormalities in hypertrophic cardiomyopathy: echocardiographic features and surgical outcomes.
abstract: BACKGROUND
  Functional and intrinsic mitral valve (MV) abnormalities are common in hypertrophic cardiomyopathy (HCM); however, morphologic characteristics constituting indications for surgical intervention are incompletely defined. This study was conducted to define the echocardiographic features of MV pathology in patients with HCM and relate these to repairability of the MV, MV procedures performed, durability of repair, and survival.
  
  
  METHODS
  From 1986 to 2003, 851 patients with HCM underwent operation, and 115 had a concomitant MV procedure. Detailed analysis of their 784 transthoracic and transesophageal echocardiograms, performed intraoperatively and postoperatively, was conducted. Outcomes were assessed by cross-sectional follow-up.
  
  
  RESULTS
  Sixty-seven patients (58%) underwent MV repair, and 48 (42%) had MV replacement. The mean left ventricular outflow tract peak gradient was 70 +/- 50 mm Hg. Systolic anterior motion was present in 95%. Valve abnormalities were degenerative in 36 (31%), myxomatous in 23 (20%), papillary muscle in 23 (20%), restrictive chordal in 22 (19%), restrictive leaflet in 80 (70%), and long leaflet in 64 (56%). Patients undergoing MV repair had higher prevalence of long leaflets and degenerative MV pathology. The anterior mitral leaflet was 3.0 +/- 0.49 cm in the repair group vs 2.5 +/- 0.40 cm in the replacement group (p = 0.0001). MV replacement patients were older, more symptomatic, and had more renal dysfunction and lower hematocrits. By 3 years, 91% of patients with a repair were free of reoperation.
  
  
  CONCLUSIONS
  Intrinsic MV pathology is frequently observed in HCM patients with symptomatic obstruction who undergo myectomy. Echocardiography can identify MV features predictive of successful valve repair. Repair, although durable, is feasible in only about half of patients.
authors.affiliation: Department of Thoracic and Cardiovascular Surgery, The Cleveland Clinic, Cleveland, Ohio 44195, USA.
authors.forename: Ryan K
authors.initials: RK
authors.lastname: Kaple
authors.forename: Ross T
authors.initials: RT
authors.lastname: Murphy
authors.forename: Linda M
authors.initials: LM
authors.lastname: DiPaola
authors.forename: Penny L
authors.initials: PL
authors.lastname: Houghtaling
authors.forename: Harry M
authors.initials: HM
authors.lastname: Lever
authors.forename: Bruce W
authors.initials: BW
authors.lastname: Lytle
authors.forename: Eugene H
authors.initials: EH
authors.lastname: Blackstone
authors.forename: Nicholas G
authors.initials: NG
authors.lastname: Smedira
mesh_terms: D000328:Adult; D000368:Aged; D002312:Cardiomyopathy, Hypertrophic / Q000000981:diagnostic imaging / Q000235:genetics* / Q000401:mortality / Q000601:surgery*; D024741:Cardiomyopathy, Hypertrophic, Familial / Q000000981:diagnostic imaging / Q000401:mortality / Q000601:surgery*; D003131:Combined Modality Therapy; D004452:Echocardiography; D005260:Female; D005500:Follow-Up Studies; D006346:Heart Septum / Q000000981:diagnostic imaging / Q000601:surgery; D019918:Heart Valve Prosthesis Implantation; D006801:Humans; D008297:Male; D008875:Middle Aged; D008943:Mitral Valve / Q000002:abnormalities* / Q000000981:diagnostic imaging / Q000601:surgery*; D011183:Postoperative Complications / Q000401:mortality; D016019:Survival Analysis; D016896:Treatment Outcome