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General Thoracic and Cardiovascular Surgery

, Volume 66, Issue 6, pp 321–326 | Cite as

Minimally invasive trans-mitral septal myectomy for diffuse-type hypertrophic obstructive cardiomyopathy

  • Taichi SakaguchiEmail author
  • Toshinori Totsugawa
  • Kentaro Tamura
  • Arudo Hiraoka
  • Genta Chikazawa
  • Hidenori Yoshitaka
Original Article
  • 288 Downloads

Abstract

Objective

Despite excellent long-term results reported for a trans-aortic septal myectomy for hypertrophic obstructive cardiomyopathy (HOCM), surgery for patients with diffuse hypertrophy is very challenging. In addition, a left ventricular outflow obstruction is often aggravated by an abnormal mitral valve and subvalvular apparatus.

Methods

We performed video-assisted minimally invasive trans-mitral septal myectomy procedures in 3 patients with diffuse-type HOCM, who were highly symptomatic despite maximal medical therapy. Each had at least moderate mitral regurgitation (MR) due to systolic anterior motion (SAM). Using a right mini-thoracotomy, the anterior mitral leaflet was detached, through which an extended septal myectomy could easily be performed. Abnormal bridging chordae between the septum and papillary muscle (PM) were divided, then anterior mitral leaflet continuity was restored with direct closure or augmentation using a glutaraldehyde-treated autologous pericardium. A PM reorientation procedure was performed in 1 case in which both PMs were approximated and sutured onto the posterior ventricular wall.

Results

The postoperative course was uneventful in all patients, with marked improvement of symptoms in each. The peak ventricular outflow gradient decreased from 134 ± 40 to 23 ± 5 mmHg with significantly diminished SAM, especially in the patient who underwent the PM reorientation procedure. During a mean follow-up period of 42 ± 14 months, no MR has been detected in any case.

Conclusions

We believe that a minimally invasive trans-mitral septal myectomy is preferable for HOCM-patients with diffuse hypertrophy and mitral valve abnormality. Aggressive PM reorientation may also be useful for those with an abnormal PM orientation.

Keywords

Minimally invasive cardiac surgery Septal myectomy Hypertrophic obstructive cardiomyopathy 

Notes

Compliance with ethical standards

Conflict of interest

The author has declared that no conflict of interest exists.

Supplementary material

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Copyright information

© The Japanese Association for Thoracic Surgery 2018

Authors and Affiliations

  1. 1.Department of Cardiovascular SurgeryThe Sakakibara Heart Institute of OkayamaOkayama CityJapan

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