Clinical outcomes of septal myectomy in hypertrophic cardiomyopathy with refractory symptoms: A single institutional experience from India

Abstract

Background: Myectomy is the surgical procedure for the treatment of hypertrophic cardiomyopathy (HCM) with refractory symptoms There is limited data available regarding the role of myectomy in HCM among the Indian population. This study is intended to assess the outcomes of myectomy in HCM. Methods: Change in the gradient across the left ventricular outflow tract and severity of mitral regurgitation after myectomy were studied using echocardiography. Functional status, exercise tolerance, and cardiac rhythm of the patients were studied before and after myectomy. Results: The study consists of eleven patients with HCM. Four patients were in NYHA grade II, seven were in NYHA grade III before surgery. After surgery nine were in NYHA grade I and two were in NYHA grade II. Exercise tolerance of the study group was in the range of 1 min before surgery and it improved to 6.27 min after surgery. LVOT gradient before surgery was 108.81 and 112.45 mm of Hg on TTE and TEE respectively and it was 17.9 and 15.63 mm of Hg on TEE and TTE respectively after myectomy. On TTE eight patients had severe MR and three had moderate MR before surgery, while nine of them had severe MR and two had moderate MR on TEE. In the immediate post-operative period nine had mild MR, one had moderate MR, whereas the remaining one patient underwent MVR. TTE at six months revealed mild MR in seven, moderate MR in two patients and one had no MR. Conclusions: Surgical septal myectomy is an effective treatment modality for obstructive HCM.

Keywords

• Hypertrophic cardiomyopathy
• Left ventricular outflow tract
• Mitral regurgitation
• Systolic anterior motion