Left ventricular reconstruction in patients with hypertrophic cardiomyopathy

• Motreva A.P.

Abstract

Background. Hypertrophic cardiomyopathy (HCM) is a primary myocardial disease with pronounced genetic, anatomical and clinical heterogeneity. Characteristic features of this disease are hyperkinetic left ventricular function and excessive primary myocardial hypertrophy. Hypertrophic cardiomyopathy (HCM) occurs in 1:200 people.

Aim. To analyze the immediate and long-term results of surgical treatment of HCM performed at the Federal Center for Cardiovascular Surgery in Astrakhan from June 2017 to July 2023.

Material and methods. Data from surgical treatment of HCM were analyzed in 220 patients aged 13 to 74 years who underwent surgical remodeling of the left ventricle. The diagnosis of HCM was established on the basis of a clinical and instrumental examination, which included a general examination, collection of personal and family history, resting and 24-hours ECG, transthoracic and transesophageal (intraoperative) echocardiography, MRI with gadolinium, and molecular genetic research. Patients are divided into two groups based on the phenotype of the disease: basal and diffuse generalized HCM.

Results. The study involved 128 patients with the basal phenotype of HCM and 92 patients with a  diffuse generalized phenotype of the disease. Combined operations were performed in 33 patients  in both groups. Hospital mortality was 0.9%.

Conclusion. The anatomy of HCM and the clinical condition of the patient determine the strategy and tactics of treatment.

Combined surgical procedures for HCM are a consequence of the complex nature of intracardiac obstruction and require a comprehensive expert diagnosis. This kind of interventions are absolutely necessary and do not reduce the results of the main operation, extended myectomy.

Phenotype, genotype, and their relationship should be taken into account when deciding how to prevent sudden cardiac death.

Extended myectomy surgery is complex, but effective and safe procedure.

Keywords: hypertrophic cardiomyopathy (HCM); septal myectomy; diffuse generalized HCM; basal HCM

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