Humans ; Apical Hypertrophic Cardiomyopathy ; Heart Aneurysm/complications* ; Cardiomyopathy, Hypertrophic/complications* ; Ventricular Outflow Obstruction/etiology*

Humans ; Apical Hypertrophic Cardiomyopathy ; Heart Aneurysm/complications* ; Cardiomyopathy, Hypertrophic/complications* ; Ventricular Outflow Obstruction/etiology*

Objective: To examine the early effect of thoracoscopic trans-mitral myectomy for hypertrophic cardiomyopathy patients with left midventricular obstruction. Methods: From April 2020 to July 2021, 10 hypertrophic cardiomyopathy patients with left midventricular obstruction underwent thoracoscopic trans-mitral myectomy at Guangdong Provincial People's Hospital. The whole group of patients consisted of 7 males and 3 females aged (52.0±16.4) years (range: 18 to 68 years). The EuroSCORE Ⅱ predicted mortality rate was 1.78% (1.20%) (M(IQR)) (range: 0.96% to 4.86%). The clinical data were collected and analyzed retrospectively to evaluate the clinical efficacy by comparing preoperative and postoperative echocardiographic parameters using paired t-test, paired Wilcoxon test or Fisher exact test, including left ventricular outflow tract peak pressure gradient, maximum interventricular septum thickness, systolic anterior motion of the anterior mitral leaflet and so on. The safety was determined by summarizing the incidence of perioperative and follow-up complications. Results: All the procedures successed with no conversion to median sternotomy, septal defect, ventricular rupture. There was no in-hospital 30-day death, neither serious complications like permanent pacemaker implantation, re-sternotomy for bleeding, low cardiac output syndrome, stroke, or multiple organ dysfunction syndrome. The left ventricular outflow tract obstruction was effectively relieved in all patients expect a patient developed residual obstruction. Compared with that of pre-operation, the thickness of the interventricular septum was significantly reduced from (22.1±4.0) mm to (10.3±1.7) mm (t=10.693, P<0.01), while the left ventricular outflow tract peak pressure gradient was significantly reduced from (81.7±21.1) mmHg to 12.3 (11.5) mmHg (Z=-2.805, P<0.01) (1 mmHg=0.133 kPa). Conclusion: Thoracoscopic trans-mitral myectomy is an effective and safe procedure for hypertrophic cardiomyopathy patients with left midventricular obstruction.
Male ; Female ; Humans ; Retrospective Studies ; Echocardiography ; Treatment Outcome ; Cardiomyopathy, Hypertrophic/complications* ; Ventricular Septum

Atrial Fibrillation/complications* ; Cardiomyopathy, Hypertrophic/complications* ; Humans ; Thromboembolism/prevention & control*

Anticoagulants ; therapeutic use ; Cardiomyopathy, Hypertrophic ; complications ; diagnostic imaging ; therapy ; Coronary Angiography ; Death, Sudden, Cardiac ; prevention & control ; Defibrillators, Implantable ; Echocardiography ; Electric Countershock ; Electrocardiography ; Heart Aneurysm ; complications ; diagnostic imaging ; therapy ; Humans ; Magnetic Resonance Imaging ; Male ; Middle Aged ; Tachycardia, Ventricular ; diagnosis ; etiology ; therapy

No abstract available.
Adolescent ; Adrenergic beta-Antagonists/therapeutic use ; Calcium Channel Blockers/therapeutic use ; Cardiomyopathy, Hypertrophic, Familial/complications/genetics/*pathology/physiopathology/therapy ; Electric Countershock ; Electrocardiography ; Female ; Genetic Predisposition to Disease ; Heart Failure/etiology/therapy ; Heart Septum/drug effects/*pathology/physiopathology/ultrasonography ; Humans ; Magnetic Resonance Imaging ; Male ; Middle Aged ; Pedigree ; Phenotype ; Tachycardia, Ventricular/etiology/therapy ; Treatment Outcome ; Ventricular Outflow Obstruction/etiology

Asymmetric septal hypertrophy with systolic anterior motion of the mitral valve is frequently a phenotypic, but not pathognomonic, expression of genetic hypertrophic cardiomyopathy (HCM) with or without obstruction. It can, however, be associated nonspecifically with other forms of increased left ventricular (LV) afterload. We herein report the case of a young man with obesity cardiomyopathy and heart failure who presented with asymmetric septal hypertrophy and marked LV hypertrophy, and endomyocardial biopsy ruled out genetic HCM.
Adult ; Cardiomyopathy, Hypertrophic, Familial ; Diagnosis, Differential ; Echocardiography ; Humans ; Hypertrophy, Left Ventricular ; complications ; diagnosis ; Male ; Obesity, Morbid ; complications

Medically refractory ventricular tachycardia (VT) storm can be controlled with radiofrequency catheter ablation (RFCA), however, it may be difficult to control in some patients with hemodynamic overload. We experienced a patient with intractable VT storm controlled by hemodynamic unloading. The patient had mid-septal hypertrophic cardiomyopathy with an implantable cardioverter defibrillator (ICD) back-up. Because of the severe mid-septal hypertrophy, his left ventricle (LV) had an hourglass-like morphology and showed apical ballooning; the focus of VT was at the border of apical ballooning. Although we performed VT ablation because of electrical storm with multiple ICD shocks, VT recurred 1 hour after procedure. As the post-RFCA monomorphic VT was refractory to anti-tachycardia pacing or ICD shock, we reduced the hemodynamic overload of LV with beta-blockade, hydration, and sedation. VT spontaneously stopped 1.5 hours later and the patient has remained free of VT for 24 months with beta-blockade alone. In patients with VT storm refractory to antiarrhythmic drugs or RFCA, the mechanism of mechano-electrical feedback should be considered and hemodynamic unloading may be an essential component of treatment.
Cardiomyopathy, Hypertrophic/complications/diagnosis/*physiopathology/therapy ; Catheter Ablation ; Electrocardiography ; Gated Blood-Pool Imaging ; Heart Catheterization ; Humans ; Male ; Middle Aged ; Tachycardia, Ventricular/diagnosis/etiology/*physiopathology/therapy ; Takotsubo Cardiomyopathy/complications/diagnosis/*physiopathology/therapy

Aged ; Cardiomyopathy, Hypertrophic ; diagnosis ; Diagnostic Errors ; Female ; Humans ; Hypertrophy, Left Ventricular ; complications ; diagnosis

OBJECTIVETo investigate the alteration of the adiponectin signal pathway in hypertrophic myocardium of spontaneous hypertensive rats (SHR) and to observe the effects of Gadol (GD) and Ganoderma spores (GS) on the hemodynamic parameters and the adiponectin signal pathway of SHR.

METHODSSHRs, 8 weeks old, were randomly divided into four groups: the untreated group, and the three treated groups treated with GD, GS, and GD + GS respectively by gastrogavage for 4 weeks. Controlled with 8-week-old WKY rats, the hemodynamic parameters in all rats were recorded through the carotid artery intubation; the serum level of adiponectin was determined with ELISA; the mRNA expressions of adiponectin receptors (AdipoRs) and carnitine palmitoyl transferase (CPT-1) were determined by RT-PCR; and the protein expression of adenosine monophosphate activated protein kinase (AMPK), both phosphorylated and un-phosphorylated, was detected by Western blot.

RESULTSCompared with the WKY rats, the systolic blood pressure (SBP), diastolic blood pressure (DBP) and myocardial hypertrophy index (MHI) in SHR were significantly higher; the serum levels of adiponectin and phosphorylated AMPK, mRNA expressions of AdipoR1 and CPT-1 in SHR heart tissue were lower (P < 0.05). Compared with the SHR, medication of GD and GS, either alone or in combination, could reduce SBP, DBP and MHI significantly (P < 0.01, P < 0.05), and elevate the mRNA expression of CPT-1 (P < 0.05) in heart, but levels of adiponectin, AdipoR1 and phosphorylated AMPK could only be raised by combined use of the two (P < 0.05).

CONCLUSIONSAdiponectin signal transduction pathway alteration presents in the myocardium of SHR, which might be one of the molecular mechanisms that cause hypertrophic metabolic abnormality. GD and GS could improve the hemodynamic index in SHR, and enhance the level of adiponectin and the expression of its related signal transduction molecules.

Adiponectin ; metabolism ; physiology ; Animals ; Cardiomyopathy, Hypertrophic ; etiology ; metabolism ; Drugs, Chinese Herbal ; pharmacology ; Ganoderma ; chemistry ; Hemodynamics ; drug effects ; Hypertension ; complications ; Male ; Random Allocation ; Rats ; Rats, Inbred SHR ; Rats, Inbred WKY ; Rhodiola ; chemistry ; Signal Transduction ; drug effects ; Spores