Transapical myectomy as an alternative to heart transplantation in patient with apical hypertrophic cardiomyopathy
Abstract
41 y.o. female
patient with NYHA class III was admitted to the hospital with dyspnea and
angina occurred during ordinal physical activities despite of provided medical
therapy. Echo data: LV volume 56 ml, maximal LV wall thickness 19 mm, LVEF 67%,
LVEDV 46 ml, LVSV 28 ml. Resting LVOT gradient 8 mm Hg. During the last 6
months patient has been included at
heart transplant waitlist. In term of severely symptomatic status, progressive
heart failure, LV apical aneurysm formation with transmural fibrosis,
ineffective medical therapy, significant LVEDV and LVSV reduction, and low
surgical risk patient was scheduled to transapical myectomy as an alternative
to heart transplantation. Postoperative period was unconventional. Echo: LV
volume 51 ml, maximal LV wall thickness 15 mm, LVEF 72%, LVEDV 88 ml, LVSV 63
ml. Resting LVOT gradient 7 mm Hg. Cardiac output has increased from 2.1l/min to 4.6l/min, 6MWT has
increased from less than 50 m to 200 m. Conclusion. Severely symptomatic patients
with apical HCM, significant LV diastolic disfunction and small LV cavity
should be considered as candidates to transapical myectomy, in particular as an
alternative to heart transplantation.
Keywords:hypertrophic cardiomyopathy; transapical myectomy
Funding. The study had no sponsor support.
Conflict of
interest. The authors declare no conflict of interest.
For citation: Afanasyev A.V., Bogachev-Prokophiev A.V., Kirilova V.S., Volkova I.I.,
Kashapov R.I., Shajahmetova S.V., Zalesov A.S., Pivkin A.N., Nazarov V.M.,
Chernyavskiy A.M. Transapical myectomy as an alternative to heart
transplantation in patient with apical hypertrophic cardiomyopathy. Clinical
and Experimental Surgery. Petrovsky Journal. 2024; 12 (1): 127–34. DOI: https://doi.org/10.33029/2308-1198-2024-12-1-127-134
(in Russian)
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