1 . 2024

Surgical treatment of the midventricular form of obstructive hypertrophic cardiomyopathy

Abstract

Background. Currently, the problems of indications for surgical treatment of the midventricular form of hypertrophic cardiomyopathy (HCM) are being intensively discussed.

Aim. To study the immediate and medium-long-term results of surgical treatment of the midventricular form of HCM.

Material and methods. The results of surgical treatment of 25 patients aged from 23 to 75 years (mean age 49.2±14.9 years) diagnosed with HCM with midventricular obstruction or in combination with obstruction of the left ventricular outflow tract were analyzed.

Results. In 19 cases, transaortic extended myectomy was performed in combination with resection of subvalvular structures (9), reorientation of papillary muscles (5) or “edge-to-edge” mitral valve repair by Alfieri (15). In one case, transapical myoectomy with LV aneurysm repair was performed, in 5 patients, mitral valve replacement was performed. There was a significant decrease in the thickness of the IVS and a decrease in the peak gradient in the basal and middle sections of the IVS. The SAM-syndrome observed in patients before surgery was absent after surgery. No deaths were observed.

1 year after surgery, there were no relapses of increased pressure gradients in the basal and middle sections of the IVS. An increase in residual mitral regurgitation was also not detected. An increase in LV volume was noted in dynamics. The functional class of heart failure according to NYHA decreased from II–III to I–II.

Conclusion. Extended septal myectomy in combination with interventions on the subvalvular structures makes it possible to eliminate obstruction in the middle and basal LV and increase the volume of LV.

Keywords:hypertrophic cardiomyopathy; midventricular obstruction; septal myectomy

Funding. The study had no sponsor support.

Conflict of interest. The authors declare no conflict of interest.

For citation: Zainetdinov M.R., Dzhordzhikiya R.K., Mukharyamov M.N. Surgical treatment of the midventricular form of obstructive hypertrophic cardiomyopathy. Clinical and Experimental Surgery. Petrovsky Journal. 2024; 12 (1): 15–22. DOI: https://doi.org/10.33029/2308-1198-2024-12-1-15-22 (in Russian)

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