Extended septal myectomy for children and adolescents with hypertrophic obstructive cardiomyopathy (HOCM) is a challenging procedure, and related data are currently limited. Our study objective was to assess the early outcomes in children and adolescents with HOCM after extended septal myectomy. From October 2007 to August 2015, 40 consecutive patients with HOCM underwent transaortic extended septal myectomy in Fuwai Hospital, Beijing, China. Patients clinical data were analyzed retrospectively. Mean age at the time of operation was 11.3 ± 4.3 (0.7–16.7) years. Mean body weight at the time of surgery was 40.8 ± 19.7 (4.3–92.0) kg. After myectomy, mean left ventricular outflow tract gradient decreased from 80.1 ± 33.8 to 14.7 ± 11.5 mmHg and mean degree of mitral regurgitation decreased from 1.9 ± 0.9 to 0.5 ± 0.5 (p < 0.001 for both). Concomitant surgical procedures were required in 13 patients (32.5 %). There was no early death. Residual systolic anterior motion and left ventricular outflow tract obstruction were reported in two and three patients, respectively. Moderate aortic regurgitation was found in one patient during a follow-up of 26.4 ± 15.1 months. Restrictive symptoms were improved in the patients with New York Heart Association functional class I or II. A 15.8-year-old patient died 16 months after operation. A permanent pacemaker was installed in one patient 3 months after operation. Extended septal myectomy is safe and effective in children and adolescents with HOCM, with excellent clinical and echocardiographic outcome at early follow-up.
Pediatric Hypertrophic obstructive cardiomyopathy Surgery
This is a preview of subscription content, log in to check access.
We gratefully acknowledge the role of all our colleagues, perfusionists, nurses, and others involved in the care of the study patients.
Compliance with Ethical Standards
Conflict of interest
The authors declare that they have no conflict of interest.
Maron BJ, Casey SA, Poliac LC et al (1999) Clinical course of hypertrophic cardiomyopathy in a regional United States cohort. JAMA 281:650–655CrossRefPubMedGoogle Scholar
Lipshultz SE, Cochran TR, Briston DA et al (2013) Pediatric cardiomyopathies: causes, epidemiology, clinical course, preventive strategies and therapies. Future Cardiol 9:817–848CrossRefPubMedPubMedCentralGoogle Scholar
Pahl E, Sleeper LA, Canter CE et al (2012) Incidence of and risk factors for sudden cardiac death in children with dilated cardiomyopathy. J Am Coll Cardiol 59:607–615CrossRefPubMedPubMedCentralGoogle Scholar
Elliott PM, Anastasakis A, Borger MA et al (2014) 2014 ESC guidelines on diagnosis and management of hypertrophic cardiomyopathy. Kardiol Pol 72:1054–1126CrossRefPubMedGoogle Scholar
Minakata K, Dearani JA, O’Leary PW et al (2005) Septal myectomy for obstructive hypertrophic cardiomyopathy in pediatric patients: early and late results. Ann Thorac Surg 80:1424–1430CrossRefPubMedGoogle Scholar
Altarabsheh SE, Dearani JA, Burkhart HM et al (2013) Outcome of septal myectomy for obstructive hypertrophic cardiomyopathy in children and young adults. Ann Thorac Surg 95:663–669CrossRefPubMedGoogle Scholar
Ten Cate FJ, Soliman OII, Michels M et al (2010) Long-term outcome of alcohol septal ablation in patients with obstructive hypertrophic cardiomyopathy: a word of caution. Circ Heart Fail 3:362–369CrossRefPubMedGoogle Scholar
Agarwal S, Tuzcu EM, Desai MY et al (2010) Updated meta-analysis of septal alcohol ablation versus myectomy for hypertrophic cardiomyopathy. J Am Coll Cardiol 55:823–834CrossRefPubMedGoogle Scholar
Alam M, Dokainish H, Lakkis N (2006) Alcohol septal ablation for hypertrophic obstructive cardiomyopathy: a systematic review of published studies. J Interv Cardiol 19:319–327CrossRefPubMedGoogle Scholar
Jensen MK, Almaas VM, Jacobsson L et al (2011) Long-term outcome of percutaneous transluminal septal myocardial ablation in hypertrophic obstructive cardiomyopathy: a scandinavian multicenter study. Circ Cardiovasc Interv 4:256–265CrossRefPubMedGoogle Scholar
Alam M, Dokainish H, Lakkis NM (2009) Hypertrophic obstructive cardiomyopathy-alcohol septal ablation vs. myectomy: a meta-analysis. Eur Heart J 30:1080–1087CrossRefPubMedGoogle Scholar
Minakata K, Dearani JA, Schaff HV (2005) Mechanisms for recurrent left ventricular outflow tract obstruction after septal myectomy for obstructive hypertrophic cardiomyopathy. Ann Thorac Surg 80:851–856CrossRefPubMedGoogle Scholar
Maron BJ, McIntosh CL, Klues HG (1993) Morphologic basis for obstruction to right ventricular outflow in hypertrophic cardiomyopathy. Am J Cardiol 71:1089–1094CrossRefPubMedGoogle Scholar
Quintana E, Johnson JN, Rotes AS et al (2015) Surgery for biventricular obstruction in hypertrophic cardiomyopathy in children and young adults: technique and outcomes. Eur J Cardio-Thorac 47:1006–1012CrossRefGoogle Scholar
Borisov KV (2013) Surgical correction of hypertrophic obstructive cardiomyopathy in patients with simultaneous obstruction of left ventricular midcavity and right ventricular outflow tract. Eur J Cardiothorac Surg 43:67–72CrossRefPubMedGoogle Scholar
Melacini P, Maron BJ, Bobbo F et al (2007) Evidence that pharmacological strategies lack efficacy for the prevention of sudden death in hypertrophic cardiomyopathy. Heart 93:708–710CrossRefPubMedPubMedCentralGoogle Scholar
Maron BJ, Spirito P, Ackerman MJ et al (2013) Prevention of sudden cardiac death with implantable cardioverter-defibrillators in children and adolescents with hypertrophic cardiomyopathy. J Am Coll Cardiol 61:1527–1535CrossRefPubMedGoogle Scholar
1.Department of Pediatric Cardiac Surgery, National Center for Cardiovascular Disease and Fuwai Hospital, Chinese Academy of Medical SciencesPeking Union Medical CollegeBeijingPeople’s Republic of China
2.Department of Cardiopulmonary Bypass, National Center for Cardiovascular Disease and Fuwai Hospital, Chinese Academy of Medical SciencesPeking Union Medical CollegeBeijingPeople’s Republic of China