Surgical Results in Patients with Hypertrophic Obstructive Cardiomyopathy

Abstract

Hypertrophic obstructive cardiomyopathy (HOCM) — a disease of unknown etiology — is characterized by a hypertrophied left ventricle (LV) with a relatively small cavity, an asymmetric subaortic and/or midventricular or apical septal hypertrophy which may cause a considerable systolic obstruction of the left ventricular outflow-tract (LVOT) and diastolic LV dysfunction by delayed relaxation and filling impairment. In many cases a mitral regurgitation of different degrees and clinical importance can be found. Data of the natural history of the disease clearly indicate a slow continuing clinical deterioration. Sudden death — mainly in younger age groups and often after acute physical exertion — is a typical complication. Patients are additionally endangered by arrhythmias, systemic embolism, endocarditis, and congestive heart failure (CHF). The most important diagnostic procedures are listed in (Table 1). In our experience, clinical examination, carotid pulse tracings, echocardiography, Doppler echochardiography, transseptal left heart catheterization, and cineangiocardiography are the most important diagnostic tools. Management of clinically symptomatic HOCM (Table 2) was started medically using β-adrenergic blocking agents (propranolol [16], mainly to prevent provocation of the obstruction by beta-agonists [59]). Later Kaltenbach et al. [22] reported a good clinical response by using the calcium antagonist verapamil. Antiarrhythmic drugs were introduced by Wigle et al. [50] (disopyramide) or by McKenna et al. [32] (amiodarone).