OBJECTIVETo summarize the experiences and results of ventricular septal myectomy concomitant mitral valve replacement (MVR) for obstructive hypertrophic cardiomyopathy (OHCM).

METHODSFrom January 2000 to June 2007, 22 patients of OHCM with moderate or severe mitral regurgitation underwent concomitant ventricular septal myectomy concomitant MVR. There were 20 male and 2 female patients. The age ranged from 28 to 51 years old with a mean of (36 + or - 5) years old. The left ventricular out tract gradient pressure (LVOTGP) was 55 to 120 mm Hg (1 mm Hg = 0.133 kPa), with a mean of (88.0 + or - 15.8) mm Hg. The manifestation of pre-operative UCG, intra-operative transesophageal echocardiography (TEE) and post-operative UCG in 10 d, 6 months and 1 year were compared and analyzed.

RESULTSOne patient died in hospital due to serious ventricular arrhythmias. The intra-operative TEE showed that the phenomenon of systolic anterior motion (SAM) of mitral valve disappeared in all patients. Twenty-one cases were followed-up. The intra-operative TEE and post-operative UCG in every period of all 21 cases survived indicated that the mean LVOTGP and interventricular septal thickness (IVST) decreased obviously (P < 0.01).

CONCLUSIONConcomitant ventricular septal myectomy concomitant MVR is an effective and safe treatment for OHCM with moderate or severe mitral regurgitation, the short and mid-term outcome is excellent.

Adult ; Cardiomyopathy, Hypertrophic ; complications ; surgery ; Female ; Heart Valve Prosthesis Implantation ; Humans ; Male ; Middle Aged ; Mitral Valve ; surgery ; Mitral Valve Insufficiency ; complications ; surgery ; Retrospective Studies ; Treatment Outcome ; Ventricular Septum ; surgery

Adult ; Aged ; Bundle-Branch Block ; etiology ; Cardiomyopathy, Hypertrophic ; surgery ; Catheter Ablation ; adverse effects ; methods ; Female ; Heart Septum ; surgery ; Humans ; Male ; Middle Aged ; Postoperative Complications ; etiology

Cases of iatrogenic coronary artery fistulas draining into the left ventricle after surgical myectomy for hypertrophic obstructive cardiomyopathy have been published as sporadic reports. However, its management scheme and prognosis are not clear because of the low incidence. A 46-yr-old woman was hospitalized for evaluation of chest pain and shortness of breath for 3 months. Transthoracic echocardiographic examination showed typical hypertrophic obstructive cardiomyopathy with a peak pressure gradient of 71 mmHg across the left ventricular outflow tract. The patient underwent surgical septal myectomy. Postoperative color Doppler imaging revealed a diastolic blood flow from the interventricular septal myocardium to the left ventricular cavity, i.e. iatrogenic coronary artery fistula to the left ventricle. Ten days later, the fistula closed spontaneously which was diagnosed by transthoracic echocardiography and confirmed by coronary angiography.
Vascular Fistula/diagnosis/*etiology ; Middle Aged ; *Iatrogenic Disease ; Humans ; Heart Ventricles/*abnormalities ; Heart Septum/*surgery ; Female ; Coronary Vessel Anomalies/diagnosis/*etiology ; Cardiovascular Surgical Procedures/*adverse effects ; Cardiomyopathy, Hypertrophic/complications/*surgery

OBJECTIVETo assess the complications of percutaneous tansluminal septal myocardial ablation (PTSMA) for the treatment of hypertrophic obstructive cardiomyopathy (HOCM).

METHODSSeventy-two patients with symptomatic left ventricular outflow tract obstruction were diagnosed by echocardiography or catheterization procedures. Absolute ethanol was injected into the target coronary artery branch (branches) for septal myocardial ablation. Documented complications were recorded.

RESULTSSixty-nine patients had severe chest pain, 19 developed different degrees of heart block during the periprocedural period, but only one developed a complete AV block, requiring permanent pace-maker implantation. Temporary right bundle branch block occurred in 50% of patients and permanent block occurred in 38.9% of patients. Acute inferior myocardial infarction occurred in six patients (8.3%) and acute anterior myocardial infarction occurred in one patient. During two-year follow-up of 24 cases, there were no deaths. All patients had improvement in heart function and none experienced heart failure.

CONCLUSIONThe most common complication of PTSMA is right bundle branch block. The most significant complication of the procedure is heart block. PTSMA is a good technical, non-surgical treatment for HOCM.

Adolescent ; Adult ; Arrhythmias, Cardiac ; etiology ; Cardiomyopathy, Hypertrophic ; surgery ; Catheter Ablation ; adverse effects ; Female ; Heart Block ; etiology ; Heart Septum ; surgery ; Humans ; Male ; Middle Aged ; Myocardial Infarction ; etiology ; Postoperative Complications ; etiology