title: Hypertrophic obstructive cardiomyopathy: the mitral valve could be the key.
abstract: OBJECTIVE
  As we strongly believe that treating the mitral valve abnormalities is a key feature of hypertrophic obstructive cardiomyopathy (HOCM), we have systematically corrected both the anterior and posterior leaflet (PL) size and geometry. We have analysed our immediate results and at mid-term follow-up.
  
  
  METHODS
  From March 2010 until June 2015, 16 patients with HOCM underwent surgical correction of obstruction. The mean age was 51 years old (range, 32-72 years). All were symptomatic being New York Heart Association (NYHA) class 3 (n = 4) or 4 (n = 12). All had systolic anterior motion at echocardiogram with severe mitral regurgitation (MR). Intraventricular gradient preoperatively was 73.5 mmHg (range, 50-120 mmHg). All patients underwent a double-stage procedure: first septal resection through (i) the aortic valve and (ii) the detached anterior leaflet (AL) of the mitral valve and at second, mitral valve repair by (i) reducing PL height (leaflet resection or artificial neochordae) (ii) increasing AL height with pericardial patch.
  
  
  RESULTS
  There was no in-hospital or late death. All patients were Class 1 NYHA at latest follow-up. Control echocardiography showed no MR, mean rest intraventricular gradient was 15 mmHg (range, 9-18 mmHg).
  
  
  CONCLUSIONS
  Our good mid-term results support the concept that HOCM is not only a septal disease and that the mitral valve pathology is a key component that should be addressed. For most patients, the ideal surgical treatment should consist in a two-step procedure. It is even necessary to be studied whether treating the mitral valve alone could not suffice.
authors.affiliation: Cardiothoracic Center of Monaco, Monaco Cedex, Monaco.
authors.forename: Filip
authors.initials: F
authors.lastname: Dulguerov
authors.affiliation: Cardiothoracic Center of Monaco, Monaco Cedex, Monaco.
authors.forename: Cecilia
authors.initials: C
authors.lastname: Marcacci
authors.affiliation: Cardiothoracic Center of Monaco, Monaco Cedex, Monaco.
authors.forename: Clara
authors.initials: C
authors.lastname: Alexandrescu
authors.affiliation: Cardiothoracic Center of Monaco, Monaco Cedex, Monaco National Heart and Lung Institute, Imperial College London, London, UK Sarawak General Hospital Heart Center, Kuching, Sarawak, Malaysia.
authors.forename: K M John
authors.initials: KM
authors.lastname: Chan
authors.affiliation: Cardiothoracic Center of Monaco, Monaco Cedex, Monaco National Heart and Lung Institute, Imperial College London, London, UK gdreyfus@ccm.mc.
authors.forename: Gilles D
authors.initials: GD
authors.lastname: Dreyfus
mesh_terms: D000328:Adult; D000359:Aftercare; D000368:Aged; D002312:Cardiomyopathy, Hypertrophic / Q000175:diagnosis / Q000209:etiology* / Q000601:surgery; D001026:Coronary Artery Bypass / Q000379:methods; D004452:Echocardiography; D005260:Female; D006801:Humans; D007902:Length of Stay; D018810:Magnetic Resonance Angiography; D008297:Male; D008875:Middle Aged; D008944:Mitral Valve Insufficiency / Q000150:complications* / Q000175:diagnosis / Q000601:surgery; D016896:Treatment Outcome
keywords: Aortic approach; Extensive myectomy; Hypertrophic obstructive cardiomyopathy; Mitral approach; Mitral valve repair; Systolic anterior motion