title: Transaortic Chordal Cutting: Mitral Valve Repair for Obstructive Hypertrophic Cardiomyopathy With Mild Septal Hypertrophy.
abstract: BACKGROUND
  In severely symptomatic patients with obstructive hypertrophic cardiomyopathy (HCM) and mild septal hypertrophy, mitral valve (MV) abnormalities may play an important role in MV displacement into the left ventricular (LV) outflow tract. Therefore, isolated myectomy may not relieve outflow obstruction and symptoms, and MV replacement is often the surgical alternative.
  
  
  OBJECTIVE
  This study sought to assess the clinical and hemodynamic results of cutting thickened secondary MV chordae combined with a shallow septal muscular resection in severely symptomatic patients with obstructive HCM and mild septal hypertrophy.
  
  
  METHODS
  Clinical features were compared before surgery and at most recent clinical evaluation in 39 consecutive patients with obstructive HCM.
  
  
  RESULTS
  Over a 23 ± 2 months follow-up, New York Heart Association functional class decreased from 2.9 ± 0.5 pre-operatively to 1.1 ± 1.1 post-operatively (p < 0.001), with no patient in class III at most recent evaluation. The resting outflow gradient decreased from 82 ± 43 mm Hg to 9 ± 5 mm Hg (p < 0.001) and septal thickness decreased from 17 ± 1 mm to 14 ± 2 mm (p < 0.001). No patient had MV prolapse or flail and 1 had residual moderate-to-severe MV regurgitation at most recent evaluation. MV geometry before and after surgery was compared with that of 25 consecutive patients with similar clinical profile and septal thickness that underwent isolated myectomy. After adjustment for differences in pre-operative values between the groups, the post-operative anterior MV leaflet-annulus ratio was 17% greater and tenting area 24% smaller in patients with chordal cutting, indicating that MV apparatus had moved to a more normal posterior position within the LV cavity, preventing MV systolic displacement into the outflow tract and outflow obstruction.
  
  
  CONCLUSIONS
  This procedure relieves heart failure symptoms, abolishes LV outflow gradient, and avoids MV replacement in patients with obstructive HCM and mild septal thickness.
authors.affiliation: Centro per la Cardiomiopatia Ipertrofica e le Cardiopatie Valvolari, Policlinico di Monza, Monza, Italy. Electronic address: paolo.ferrazzi@policlinicodimonza.it.
authors.forename: Paolo
authors.initials: P
authors.lastname: Ferrazzi
authors.affiliation: Divisione di Cardiologia, Ente Ospedaliero Ospedali Galliera, Genoa, Italy.
authors.forename: Paolo
authors.initials: P
authors.lastname: Spirito
authors.affiliation: USC Cardiologia, Ospedale Papa Giovanni XXIII, Bergamo, Italy.
authors.forename: Attilio
authors.initials: A
authors.lastname: Iacovoni
authors.affiliation: USC Cardiologia, Ospedale Papa Giovanni XXIII, Bergamo, Italy.
authors.forename: Alice
authors.initials: A
authors.lastname: Calabrese
authors.affiliation: Centro per la Cardiomiopatia Ipertrofica e le Cardiopatie Valvolari, Policlinico di Monza, Monza, Italy.
authors.forename: Katrin
authors.initials: K
authors.lastname: Migliorati
authors.affiliation: USC Cardiochirurgia, Ospedale Papa Giovanni XXIII, Bergamo, Italy.
authors.forename: Caterina
authors.initials: C
authors.lastname: Simon
authors.affiliation: USC Cardiochirurgia, Ospedale Papa Giovanni XXIII, Bergamo, Italy.
authors.forename: Samuele
authors.initials: S
authors.lastname: Pentiricci
authors.affiliation: Centro per la Cardiomiopatia Ipertrofica e le Cardiopatie Valvolari, Policlinico di Monza, Monza, Italy.
authors.forename: Daniele
authors.initials: D
authors.lastname: Poggio
authors.affiliation: Centro per la Cardiomiopatia Ipertrofica e le Cardiopatie Valvolari, Policlinico di Monza, Monza, Italy.
authors.forename: Massimiliano
authors.initials: M
authors.lastname: Grillo
authors.affiliation: Centro per la Cardiomiopatia Ipertrofica e le Cardiopatie Valvolari, Policlinico di Monza, Monza, Italy.
authors.forename: Pietro
authors.initials: P
authors.lastname: Amigoni
authors.affiliation: Laboratorio Genetica Medica, Ospedale Papa Giovanni XXIII, Bergamo, Italy.
authors.forename: Maria
authors.initials: M
authors.lastname: Iascone
authors.affiliation: Centro per la Cardiomiopatia Ipertrofica e le Cardiopatie Valvolari, Policlinico di Monza, Monza, Italy.
authors.forename: Andrea
authors.initials: A
authors.lastname: Mortara
authors.affiliation: Hypertrophic Cardiomyopathy Center, Minneapolis Heart Institute Foundation, Minneapolis, Minnesota.
authors.forename: Barry J
authors.initials: BJ
authors.lastname: Maron
authors.affiliation: USC Cardiologia, Ospedale Papa Giovanni XXIII, Bergamo, Italy.
authors.forename: Michele
authors.initials: M
authors.lastname: Senni
authors.affiliation: Istituto Nazionale per la Ricerca sul Cancro, Genoa, Italy.
authors.forename: Paolo
authors.initials: P
authors.lastname: Bruzzi
mesh_terms: D006348:Cardiac Surgical Procedures / Q000379:methods*; D002312:Cardiomyopathy, Hypertrophic / Q000150:complications / Q000000981:diagnostic imaging / Q000601:surgery*; D004452:Echocardiography; D005260:Female; D005500:Follow-Up Studies; D006346:Heart Septum / Q000000981:diagnostic imaging / Q000601:surgery*; D006801:Humans; D008297:Male; D008943:Mitral Valve / Q000601:surgery*; D012189:Retrospective Studies; D016896:Treatment Outcome; D014694:Ventricular Outflow Obstruction / Q000000981:diagnostic imaging / Q000209:etiology / Q000601:surgery*
keywords: heart failure; septal myectomy; ventricular septum