Download PDF
Thorac Cardiovasc Surg 2022; 70(01): 018-025
DOI: 10.1055/s-0040-1716896
Original Cardiovascular

Exercise Echocardiography following Septal Myectomy for Hypertrophic Obstructive Cardiomyopathy

Johan Novén 
1   Department of Cardiothoracic Surgery, Skane University Hospital, Lund University, Lund, Sweden
,
Martin Stagmo
2   Department of Cardiology, Skane University Hospital, Lund University, Lund, Sweden
,
Per Wierup
3   Department of Thoracic and Cardiovascular Surgery, Cleveland Clinic, Cleveland, Ohio, United States
,
Shahab Nozohoor
1   Department of Cardiothoracic Surgery, Skane University Hospital, Lund University, Lund, Sweden
,
Henrik Bjursten
1   Department of Cardiothoracic Surgery, Skane University Hospital, Lund University, Lund, Sweden
,
Johan Sjögren
1   Department of Cardiothoracic Surgery, Skane University Hospital, Lund University, Lund, Sweden
,
Igor Zindovic
1   Department of Cardiothoracic Surgery, Skane University Hospital, Lund University, Lund, Sweden
,
Sigurdur Ragnarsson 
1   Department of Cardiothoracic Surgery, Skane University Hospital, Lund University, Lund, Sweden
› Author Affiliations
› Further Information
    Permissions and Reprints All articles of this category

Abstract

Objectives To investigate outcome after septal myectomy and to evaluate long-term hemodynamics with exercise echocardiography.

Methods This study included 40 consecutive patients operated with septal myectomy for hypertrophic obstructive cardiomyopathy from January 1998 to August 2017 at Skane University Hospital, Lund, Sweden. Perioperative clinical data and echocardiography measurements were reviewed retrospectively. Patients (n = 36) who were alive and living in Sweden were invited for exercise echocardiography to evaluate exercise capacity and hemodynamics, of whom 19 patients performed exercise echocardiography.

Results Overall survival was 100% at 1 year and 96% at 5 years following surgery. Preoperative median resting peak LVOT (left ventricular outflow tract) gradient was 80 mm Hg. Septum thickness was reduced from 22 ± 4 mm preoperatively to 16 ± 3 mm postoperatively (p < 0.001). During exercise echocardiography, the peak LVOT gradient was 8 mm Hg at rest, and increased to 13 mm Hg during exercise echocardiography (p = 0.002). None of the patients had dynamic LVOT obstruction during exercise echocardiography, and there was no clinically significant systolic anterior motion or severe mitral insufficiency during exercise.

Conclusions Long-term survival following septal myectomy is very good. At long-term follow-up, LVOT gradients were low and exercise echocardiography demonstrated good hemodynamics.

Keywords

hypertrophic obstructive cardiomyopathy - septal myectomy - exercise echocardiography


Publication History

Received: 13 May 2020

Accepted: 18 August 2020

Article published online:
20 November 2020

© 2020. Thieme. All rights reserved.

Georg Thieme Verlag KG
Rüdigerstraße 14, 70469 Stuttgart, Germany

 

  • References

  • 1 Maron BJ, Gardin JM, Flack JM, Gidding SS, Kurosaki TT, Bild DE. Prevalence of hypertrophic cardiomyopathy in a general population of young adults. Echocardiographic analysis of 4111 subjects in the CARDIA Study. Coronary Artery Risk Development in (Young) Adults. Circulation 1995; 92 (04) 785-789
    CrossrefPubMedGoogle Scholar
  • 2 Maron BJ. Hypertrophic cardiomyopathy: a systematic review. JAMA 2002; 287 (10) 1308-1320
    CrossrefPubMedGoogle Scholar
  • 3 Maron BJ, Peterson EE, Maron MS, Peterson JE. Prevalence of hypertrophic cardiomyopathy in an outpatient population referred for echocardiographic study. Am J Cardiol 1994; 73 (08) 577-580
    CrossrefPubMedGoogle Scholar
  • 4 Maron BJ, Casey SA, Haas TS, Kitner CL, Garberich RF, Lesser JR. Hypertrophic cardiomyopathy with longevity to 90 years or older. Am J Cardiol 2012; 109 (09) 1341-1347
    CrossrefPubMedGoogle Scholar
  • 5 Maron BJ, Ommen SR, Semsarian C, Spirito P, Olivotto I, Maron MS. Hypertrophic cardiomyopathy: present and future, with translation into contemporary cardiovascular medicine. J Am Coll Cardiol 2014; 64 (01) 83-99
    CrossrefPubMedGoogle Scholar
  • 6 Maron MS, Olivotto I, Zenovich AG. et al. Hypertrophic cardiomyopathy is predominantly a disease of left ventricular outflow tract obstruction. Circulation 2006; 114 (21) 2232-2239
    CrossrefPubMedGoogle Scholar
  • 7 Rowin EJ, Maron BJ, Olivotto I, Maron MS. Role of exercise testing in hypertrophic cardiomyopathy. JACC Cardiovasc Imaging 2017; 10 (11) 1374-1386
    CrossrefPubMedGoogle Scholar
  • 8 Smedira NG, Lytle BW, Lever HM. et al. Current effectiveness and risks of isolated septal myectomy for hypertrophic obstructive cardiomyopathy. Ann Thorac Surg 2008; 85 (01) 127-133
    CrossrefPubMedGoogle Scholar
  • 9 Pelliccia F, Niccoli G, Gragnano F. et al. Alcohol septal ablation for hypertrophic obstructive cardiomyopathy: a contemporary reappraisal. EuroIntervention 2019; 15 (05) 411-417
    CrossrefPubMedGoogle Scholar
  • 10 Maron BJ, Nishimura RA. Surgical septal myectomy versus alcohol septal ablation: assessing the status of the controversy in 2014. Circulation 2014; 130 (18) 1617-1624
    CrossrefPubMedGoogle Scholar
  • 11 Ommen SR, Maron BJ, Olivotto I. et al. Long-term effects of surgical septal myectomy on survival in patients with obstructive hypertrophic cardiomyopathy. J Am Coll Cardiol 2005; 46 (03) 470-476
    CrossrefPubMedGoogle Scholar
  • 12 Merrill WH, Friesinger GC, Graham Jr TP. et al. Long-lasting improvement after septal myectomy for hypertrophic obstructive cardiomyopathy. Ann Thorac Surg 2000; 69 (06) 1732-1735 , discussion 1735–1736
    CrossrefPubMedGoogle Scholar
  • 13 Minami K, Boethig D, Woltersdorf H, Seifert D, Körfer R. Long term follow-up of surgical treatment of hypertrophic obstructive cardiomyopathy (HOCM): the role of concomitant cardiac procedures. Eur J Cardiothorac Surg 2002; 22 (02) 206-210
    CrossrefPubMedGoogle Scholar
  • 14 Hlatky MA, Boineau RE, Higginbotham MB. et al. A brief self-administered questionnaire to determine functional capacity (the Duke Activity Status Index). Am J Cardiol 1989; 64 (10) 651-654
    CrossrefPubMedGoogle Scholar
  • 15 Sherrid MV, Chaudhry FA, Swistel DG. Obstructive hypertrophic cardiomyopathy: echocardiography, pathophysiology, and the continuing evolution of surgery for obstruction. Ann Thorac Surg 2003; 75 (02) 620-632
    CrossrefPubMedGoogle Scholar
  • 16 Levine RA, Vlahakes GJ, Lefebvre X. et al. Papillary muscle displacement causes systolic anterior motion of the mitral valve. Experimental validation and insights into the mechanism of subaortic obstruction. Circulation 1995; 91 (04) 1189-1195
    CrossrefPubMedGoogle Scholar
  • 17 Rastegar H, Boll G, Rowin EJ. et al. Results of surgical septal myectomy for obstructive hypertrophic cardiomyopathy: the Tufts experience. Ann Cardiothorac Surg 2017; 6 (04) 353-363
    CrossrefPubMedGoogle Scholar
  • 18 Vanderlaan RD, Woo A, Ralph-Edwards A. Isolated septal myectomy for hypertrophic obstructive cardiomyopathy: an update on the Toronto General Hospital experience. Ann Cardiothorac Surg 2017; 6 (04) 364-368
    CrossrefPubMedGoogle Scholar
  • 19 Kim LK, Swaminathan RV, Looser P. et al. Hospital volume outcomes after septal myectomy and alcohol septal ablation for treatment of obstructive hypertrophic cardiomyopathy: US Nationwide Inpatient Database, 2003-2011. JAMA Cardiol 2016; 1 (03) 324-332
    CrossrefPubMedGoogle Scholar
  • 20 Kayalar N, Schaff HV, Daly RC, Dearani JA, Park SJ. Concomitant septal myectomy at the time of aortic valve replacement for severe aortic stenosis. Ann Thorac Surg 2010; 89 (02) 459-464
    CrossrefPubMedGoogle Scholar
  • 21 Quiñones MA, Otto CM, Stoddard M, Waggoner A, Zoghbi WA. Doppler Quantification Task Force of the Nomenclature and Standards Committee of the American Society of Echocardiography. Recommendations for quantification of Doppler echocardiography: a report from the Doppler quantification task force of the nomenclature and standards committee of the American Society of Echocardiography. J Am Soc Echocardiogr 2002; 15 (02) 167-184
    CrossrefPubMedGoogle Scholar
  • 22 Kwon DH, Smedira NG, Thamilarasan M, Lytle BW, Lever H, Desai MY. Characteristics and surgical outcomes of symptomatic patients with hypertrophic cardiomyopathy with abnormal papillary muscle morphology undergoing papillary muscle reorientation. J Thorac Cardiovasc Surg 2010; 140 (02) 317-324
    CrossrefPubMedGoogle Scholar
  • 23 Brudin L, Jorfeldt L, Pahlm O. Comparison of two commonly used reference materials for exercise bicycle tests with a Swedish clinical database of patients with normal outcome. Clin Physiol Funct Imaging 2014; 34 (04) 297-307
    CrossrefPubMedGoogle Scholar