Hypertrophic cardiomyopathy with latent obstruction: Clinical characteristics and surgical results
Hypertrophic cardiomyopathy with latent obstruction: Clinical characteristics and surgical results
复制标题
伴潜伏性梗阻的肥厚型心肌病：临床特征和手术结果。
DOI：
10.1016/j.jjcc.2021.09.002
复制
发表时间：
2021-12-02
影响因子：
2.5
通讯作者：
Wang, ChunSheng
中科院分区：
文献类型：
--
作者：
Ji, Qiang;Wang, YuLin;Wang, ChunSheng
Background: The role of mitral subvalvular anomalies in the etiology of latent left ventricular outflow tract (LVOT) obstruction has rarely been reported; and the results of surgical treatment for latent LVOT obstruction have been infrequently reported as a separate group by other medical centers other than Mayo clinic.Methods: Among 292 eligible patients, 45 with resting gradients < 30 mmHg had provoked obstruction. Their clinical characteristics and surgical results were compared with those of 247 patients with resting LVOT obstruction. The patients were followed up for a median of 13 months.Results: Comparatively, patients with latent obstruction were younger (51.6 +/- 12.1 years vs. 57.2 +/- 11.6 years, p = 0.003) and had higher prevalence of mitral subvalvular abnormalities (73.3% vs. 16.2%, p < 0.001) and basal variant of hypertrophic cardiomyopathy (84.5% vs. 62.0%, p = 0.014), less marked septal thickness (16.9 +/- 2.8 mm vs. 18.6 +/- 3.8 mm, p = 0.005), lower resting gradients (22.2 +/- 5.7 mmHg vs. 93.0 +/- 25.7 mmHg, p < 0.001), and lower mitral regurgitation severity (median, 2.0 vs. 3.0, p < 0.001). After surgery, no surgical death occurred in patients with latent LVOT obstruction. Only one (2.2%) patient from the latent group developed complete atrioventricular block. No follow-up death or reoperation was recorded with a significant improvement in New York Heart Association functional status in either group. The provoked LVOT gradients of patients with latent obstruction decreased sharply from the preoperative value (11.8 +/- 3.7 mmHg vs. 89.8 +/- 16.4 mmHg, p < 0.001), with no occurrence of residual obstruction.Conclusions: Symptomatic patients with latent LVOT obstruction may have a higher prevalence of mitral subvalvular abnormalities and have less marked septal hypertrophy; and concomitant mitral management during myectomy for the treatment of this patient group achieved excellent results. (C) 2021 Japanese College of Cardiology. Published by Elsevier Ltd. All rights reserved.
