title: Extended myectomy for hypertrophic obstructive cardiomyopathy.
abstract: BACKGROUND
  The purpose of this study was to summarize our experience of extended ventricular septal myectomy in patients with hypertrophic obstructive cardiomyopathy (HOCM).
  
  
  METHODS
  Thirty-eight patients (26 men, 12 women) with HOCM underwent extended ventricular septal myectomy. The mean age was 36.3 years (range, 18-64 years). Diagnosis was made by echocardiography. The mean (mean ± SE) systolic gradient between the left ventricle (LV) and the aorta was 89.3 ± 31.1 mm Hg (range, 50-184 mm Hg) according to echocardiographic assessments before the operations. Moderate or severe systolic anterior motion (SAM) of the anterior leaflet of the mitral valve was found in 38 cases, and mitral regurgitation was present in 29 cases. Extended ventricular septal myectomy was performed in all 38 cases. The results of the surgical procedures were evaluated intraoperatively with transesophageal echocardiography (TEE) and with transthoracic echocardiography (TTE) at 1 to 2 weeks after the operation. All patients were followed up with TTE after their operation.
  
  
  RESULTS
  All patients were discharged without complications. The TEE evaluations showed that the mean systolic gradient between the LV and the aorta decreased from 94.8 ± 35.6 mm Hg preoperatively to 13.6 ± 10.8 mm Hg postoperatively (P = .0000) and that the mean thickness of the ventricular septum decreased from 28.3 ± 7.9 mm to 11.8 ± 3.2 mm (P = .0000). Mitral regurgitation and SAM were significantly reduced or eliminated. During the follow-up, all patients promptly became completely asymptomatic or complained of mild effort dyspnea only, and syncope was abolished. TTE examinations showed that the postoperative pressure gradient either remained the same or diminished.
  
  
  CONCLUSIONS
  Extended ventricular septal myectomy is mostly an effective method for patients with HOCM, and good surgical exposure and thorough excision of the hypertrophic septum are of paramount importance for a successful surgery.
authors.affiliation: Department of Cardiovascular Surgery, General Hospital of PLA, Institute of Cardiac Surgery of PLA, Beijing, China. gaochq301@yahoo.com
authors.forename: Changqing
authors.initials: C
authors.lastname: Gao
authors.forename: Chonglei
authors.initials: C
authors.lastname: Ren
authors.forename: Cangsong
authors.initials: C
authors.lastname: Xiao
authors.forename: Yang
authors.initials: Y
authors.lastname: Wu
authors.forename: Gang
authors.initials: G
authors.lastname: Wang
authors.forename: Guopeng
authors.initials: G
authors.lastname: Liu
authors.forename: Yao
authors.initials: Y
authors.lastname: Wang
mesh_terms: D000293:Adolescent; D000328:Adult; D006348:Cardiac Surgical Procedures / Q000009:adverse effects / Q000379:methods*; D002312:Cardiomyopathy, Hypertrophic / Q000000981:diagnostic imaging* / Q000401:mortality / Q000601:surgery*; D002315:Cardiopulmonary Bypass / Q000379:methods; D015331:Cohort Studies; D017548:Echocardiography, Transesophageal; D005260:Female; D005500:Follow-Up Studies; D006346:Heart Septum / Q000601:surgery*; D006352:Heart Ventricles / Q000601:surgery*; D006801:Humans; D007902:Length of Stay; D008297:Male; D008875:Middle Aged; D012189:Retrospective Studies; D018570:Risk Assessment; D012720:Severity of Illness Index; D056346:Sternotomy / Q000379:methods; D016896:Treatment Outcome; D055815:Young Adult