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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
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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

 

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