title: Pattern and degree of left ventricular remodeling following a tailored surgical approach for hypertrophic obstructive cardiomyopathy.
abstract: Background The role of a tailored surgical approach for hypertrophic cardiomyopathy (HCM) on regional ventricular remodelling remains unknown. The aims of this study were to evaluate the pattern, extent and functional impact of regional ventricular remodelling after a tailored surgical approach. Methods From 2005 to 2008, 44 patients with obstructive HCM underwent tailored surgical intervention. Of those, 14 were ineligible for cardiac magnetic resonance (CMR) studies. From the remainder, 14 unselected patients (42±12 years) underwent pre- and post-operative CMR studies at a median 12 months post-operatively (range 4-37 months). Regional changes in left ventricular (LV) thickness as well as global LV function following surgery were assessed using CMR Tools (London, UK). Results Pre-operative mean echocardiographic septal thickness was 21±4 mm and mean LV outflow gradient was 69±32 mmHg. Following surgery, there was a significant degree of regional regression of LV thickness in all segments of the LV, ranging from 16% in the antero-lateral midventricular segment to 41% in the anterior basal segment. Wall thickening was significantly increased in basal segments but showed no significant change in the midventricular or apical segments. Globally, mean indexed LV mass decreased significantly after surgery (120±29g/m2 versus 154±36g/m2; p<0.001). There was a trend for increased indexed LV end-diastolic volume (70±13 mL versus 65±11 mL; p=0.16) with a normalization of LV ejection fraction (68±7% versus 75±9%; p<0.01). Conclusion Following a tailored surgical relief of outflow obstruction for HCM, there is a marked regional reverse LV remodelling. These changes could have a significant impact on overall ventricular dynamics and function.
authors.affiliation: Department of Cardiac Surgery, Montreal Heart Institute, Universite de Montreal, Montreal, Canada ; Harefield Heart Science Center, National Heart and Lung Institute, Imperial College London, UK.
authors.forename: Ismail
authors.initials: I
authors.lastname: El-Hamamsy
authors.affiliation: Biomedical Engineering, Imperial College London, UK.
authors.forename: Karim
authors.initials: K
authors.lastname: Lekadir
authors.affiliation: Department of Cardiology, Azienda Ospedaliera Universitaria Careggi, Florence, Italy.
authors.forename: Iacopo
authors.initials: I
authors.lastname: Olivotto
authors.affiliation: Harefield Heart Science Center, National Heart and Lung Institute, Imperial College London, UK.
authors.forename: Ahmed
authors.initials: A
authors.lastname: El Guindy
authors.affiliation: Biomedical Engineering, Imperial College London, UK.
authors.forename: Robert
authors.initials: R
authors.lastname: Merrifield
authors.affiliation: Department of Radiology, Azienda Ospedaliera Universitaria Careggi, Florence, Italy.
authors.forename: Luigi
authors.initials: L
authors.lastname: Rega
authors.affiliation: Biomedical Engineering, Imperial College London, UK.
authors.forename: GuangZong
authors.initials: G
authors.lastname: Yang
authors.affiliation: Department of Cardiology, Azienda Ospedaliera Universitaria Careggi, Florence, Italy.
authors.forename: Franco
authors.initials: F
authors.lastname: Cecchi
authors.affiliation: Harefield Heart Science Center, National Heart and Lung Institute, Imperial College London, UK.
authors.forename: Magdi H
authors.initials: MH
authors.lastname: Yacoub
keywords: hypertrophic cardiomyopathy; tailored myectomy; ventricular remodelling