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Rational Choice of Medical and/or Surgical Therapy in Hypertrophic Cardiomyopathy

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Advances in Cardiomyopathies

Abstract

A rational choice between medical and surgical therapy in any disease entity can only exist when both forms of therapy are possible. In hypertrophic cardiomyopathy (HCM), there is a choice between medical and surgical therapy in the clinical syndromes listed in Table 1. In this review, we will discuss the various forms of medical and surgical therapy that are available to patients with HCM, but will focus on the Toronto experience, which is based on the hemodynamic classification of this disease [1–6]. We will not discuss those forms of HCM that are only amenable to medical therapy, because in those there is no rational choice between medical and surgical therapy.

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References

  1. Wigle ED, Heimbecker RO, Gunton RW (1962) Idiopathic ventricular septal hypertrophy causing muscular subaortic stenosis. Circulation 26: 325–340

    PubMed  CAS  Google Scholar 

  2. Wigle ED, Adelman MD, Felderhof CH (1974) Medical and surgical treatment of the cardiomyopathies. Circ Res 34, 35 II-196–207

    Google Scholar 

  3. Wigle ED, Sasson Z, Henderson MA, Ruddy TD, Fulop J, Rakowski H, Williams WG (1985) Hypertrophic cardiomyopathy. The importance of the site and the extent of hypertrophy. A review. Prog Cardiovasc Dis 28: 1–83

    Article  PubMed  CAS  Google Scholar 

  4. Wigle ED (1987) Hypertrophic cardiomyopathy. A 1987 viewpoint. (Editorial) Circulation 75: 311–322

    Article  CAS  Google Scholar 

  5. Wigle ED, Rakowski H (1987) Evidence for true obstruction to left ventricular outflow in obstructive hypertrophic cardiomyopathy (muscular of hypertrophic subaortic stenosis). Z Kardiol 76: 61–68

    PubMed  Google Scholar 

  6. Wigle ED (1988) Hypertrophic cardiomyopathy 1988. Mod Concepts Cardiovasc Dis 57: 1–6

    Google Scholar 

  7. Murgo JP, Alter BR, Dorethy JF, Altobelli SA, McGranahan GM Jr (1980) Dynamics of left ventricular ejection in obstructive and nonobstructive hypertrophic cardiomyopathy. J Clin Invest 66: 1369–1382

    Article  PubMed  CAS  Google Scholar 

  8. Falicov RE,Resnekov L, Bharati S et al (1976) Midventricular obstruction: a variant of obstructive cardiomyopathy. Am J Cardiol 37: 432–437

    Article  PubMed  CAS  Google Scholar 

  9. Criley MJ, Lewis KB, White RI, Ross RS (1965) Pressure gradients without obstruction: a new concept of “hypertrophic subaortic stenosis”. Circulation 22: 881–887

    Google Scholar 

  10. Grose RM, Strain JE, Spindola-Franco H (1986) Angiographic and hemodynamic correlations in hypertrophic cardiomyopathy. Am J Cardiol 58: 1085–1092

    Article  PubMed  CAS  Google Scholar 

  11. Wigle ED, Auger P, Marquis Y (1966) Muscular subaortic stenosis: the initial left ventricular inflow tract pressure as evidence of outflow tract obstruction. Can Med Assoc J 95: 793–797

    PubMed  CAS  Google Scholar 

  12. Wigle ED, Marquis Y, Auger P (1967) Muscular subaortic stenosis: Initial left ventricular inflow tract pressure in the assessment of intraventricular pressure differences in man. Circulation 35: 1100–1117

    PubMed  CAS  Google Scholar 

  13. Criley MJ, Seigel RJ (1985) Has ‘obstruction’ hindered our understanding of hypertrophic cardiomyopathy? Circulation 72: 1148–1154

    Article  PubMed  CAS  Google Scholar 

  14. Wigle ED, Adelman AG, Silver MD (1971) Pathophysiological considerations in muscular subaortic stenosis. In: Wolstenholme GEW, O’Connor M (eds) Hypertrophic obstructive cardiomyopathy. Ciba Foundation Study Group 47. Ciba Foundation, London, pp 63–76

    Google Scholar 

  15. Gilbert BW, Pollick C, Adelman AG, Wigle ED (1980) Hypertrophic cardiomyopathy: subclassification by M-mode echocardiography. Am J Cardiol 45: 861

    Article  PubMed  CAS  Google Scholar 

  16. Pollick C, Gilbert BW, Rakowski H, Morgan CD, Wigle ED (1982) Muscular subaortic stenosis: the temporal relationship between systolic anterior motion of the anterior mitral leaflet and the pressure gradient. Circulation 66: 1087–1093

    Article  PubMed  CAS  Google Scholar 

  17. Pollick C, Rakowski H, Wigle ED (1984) Muscular subaortic stenosis: the quantitative relationship between systolic anterior motion and the pressure gradient. Circulation 69-1: 43–49

    Article  Google Scholar 

  18. Glasgow GA, Gardin JM, Burns CS, Childs WJ, Henry WL (1980) Echocardiographic and Doppler flow observations in idiopathic hypertrophic subaortic stenosis (IHSS) Circulation 62:III-99 (abstr)

    Google Scholar 

  19. Bonow RO, Ostrow HG, Rosing DR, Cannon RO, Leon MB, Watson RM, Bacharach SL, Green MV, Epstein SE (1984) Dynamic pressure-volume alterations during left ventricular ejection in hypertrophic cardiomyopathy: evidence for true obstruction to left ventricular outflow. Circulation 70: 11–17 (abstr)

    Google Scholar 

  20. Hatle L, Angelsen B (1985) (eds) Doppler ultrasound in cardiology. Lea and Febiger, Philadelphia, pp 205–217

    Google Scholar 

  21. Bonow RO, Crawford-Green C, Betocci S, Rosing DR, Maron BJ (1985) Left ventricular ejection dynamics in hypertrophic cardiomyopathy: comparison with valvular aortic stenosis. J Am Coll Cardiol 5: 395 (abstr)

    Google Scholar 

  22. Pouleur H Van Eyll C, Gurne O, Hanet C, Rousseau MF (1985) Regional velocity of shortening in hypertrophic cardiomyopathy: evidence for true impedance to shortening in the presence of outflow gradients. Circulation 72: 111–448 (abstr)

    Google Scholar 

  23. Rakowski H, Sasson Z, Wigle ED (1988) Echocardiographic and Doppler assessment of hypertrophic cardiomyopathy. J Am Soc Echo 1: 31–47

    CAS  Google Scholar 

  24. Stewart WJ, Schiavone WA, Salcedo EE, Lever HM, Cosgrove DM, Grill CC (1985) Intraoperative Doppler velocity correlates with outflow gradient in HOCM pre- and postmyectomy. Circulation 72: 111–447 (abstr)

    Google Scholar 

  25. Holt B, Sahn DJ, Dalton N, Smith SC, Yun Y, Dittrich H (1985) Color Doppler flow mapping studies of jet formation in hypertrophic cardiomyopathy (HCM). Circulation 72: 111–447 (abstr)

    Google Scholar 

  26. Sasson Z, Yock PG, Hatle LK, Alderman EL, Popp R (1986) Noninvasive determination of the pressure gradient in hypertrophic cardiomyopathy. Circulation 74: 11–215 (abstr)

    Google Scholar 

  27. Wigle ED, Adelman AG, Auger P, Marquis Y (1969) Mitral regurgitation in muscular subaortic stenosis. Am J Cardiol 24: 698–706

    Article  PubMed  CAS  Google Scholar 

  28. Adelman AG, McLoughlin MJ, Marquis Y, Auger P, Wigle ED (1969) Left ventricular cineangiographic observations in muscular subaortic stenosis. Am J Cardiol 24: 689–697

    Article  PubMed  CAS  Google Scholar 

  29. Ross J Jr, Braunwald E, Gault JH, Mason DT, Morrow AG (1966) The mechanism of the intraventricular pressure gradient in idiopathic hypertrophic subaortic stenosis. Circulation 34: 558–578

    PubMed  Google Scholar 

  30. Wigle ED, Auger P, Marquis Y (1967) Muscular subaortic stenosis: the direct relation between the intraventricular pressure gradient and left ventricular ejection time. Circulation 36: 36–44

    PubMed  CAS  Google Scholar 

  31. Sasson Z, Henderson M, Wilansky S, Rakowski H, Wigle ED (1989) Causal relation between the pressure gradient and left ventricular ejection time in hypertrophic cardiomyopathy. J Am Coll Cardiol 13: 1275–1279

    Article  PubMed  CAS  Google Scholar 

  32. Maron BJ, Gottdiener JS, Arce J, Rosing DR, Wesley YE, Epstein SE (1985) Dynamic subaortic obstruction in hypertrophic cardiomyopathy: analysis by pulsed Doppler echocardiography. J Am Coll Cardiol 6: 1–15

    Article  PubMed  CAS  Google Scholar 

  33. Pierce GE, Morrow AG, Braunwad E (1964) Idiopathic hypertrophic subaortic stenosis III. Intraoperative studies of the mechanism of obstruction and its hemodynamic consequences. Circulation 30:IV, 152–207

    Google Scholar 

  34. Bircks W, Bostroem B, Gleichmann U, Kruezer H, Loogen F (1968) Electromagnetic flow measurement in the ascending aorta before and after repair of valvular and subvalvular lesions including IHSS. Proceedings of the Vth European Congress of Cardiology (Athens), pp 13–22

    Google Scholar 

  35. Jenni R, Ruffman K, Vieli A, Anlinker M, Krayenbuehl HP (1985) Dynamics of aortic flow in hypertrophic cardiomyopathy. Eur Heart J 6: 391–398

    PubMed  CAS  Google Scholar 

  36. Hernandez RR, Greenfiled JC Jr, McCall BW (1964) Pressure-flow studies in hypertrophic subaortic stenosis. J Clin Invest 43: 401–107

    Article  PubMed  CAS  Google Scholar 

  37. Cannon RO, Rosing DR, Mcintosh CL, Epstein SE (1985) Hypertrophic cardiomyopathy (HCM): improved hemodynamics, metabolism, and anginal threshold following surgical relief of obstruction. Circulation 72:III–447 (abstr)

    Google Scholar 

  38. Frank MJ, Abdulla AM, Watkins O, Prisant L, Stefadouros MA (1983) Long-term medical management of hypertrophic cardiomyopathy: usefulness of propranolol. Eur Heart J 4: 155–164

    PubMed  Google Scholar 

  39. Kaltenbach M, Hopf R, Kober G, Bussman WD, Keller M, Petersen Y (1979) Treatment of hypertrophic obstructive cardiomyopathy with verapamil. Br Heart J 42: 35–42

    Article  PubMed  CAS  Google Scholar 

  40. Kaltenbach M, Hopf R (1985) Treatment of hypertrophic cardiomyopathy: Relation to pathological mechanisms. J Mol Cell Cardiol 17: 59–68

    Article  PubMed  Google Scholar 

  41. Rosing DR, Kent KM, Border JS, Seides SF, Maron BJ, Epstein SE (1979) Verapamil therapy: a new approach to the pharmacologic treatment of hypertrophic cardiomyopathy I. Hemodynamic effects. Circulation 60: 1201–1207

    PubMed  CAS  Google Scholar 

  42. Rosing DR, Condit JR, Maron BJ, Kent KM, Leon MB, Bonow RO, Lipson LC, Epstein SE (1981) Verapamil therapy: A new approach to the pharmacologic treatment of hypertrophic cardiomyopathy: III. Effects of long-term administration. Am J Cardiol 48: 545–553

    Article  PubMed  CAS  Google Scholar 

  43. Rosing DR, Idanpaan-Heikkila U, Maron BJ, Bonnow RO, Epstein SE (1985) Use of calcium-channel blocking drugs in hypertrophic cardiomyopathy. Am J Cardiol 55 (Suppl) 185B–195B

    Article  PubMed  CAS  Google Scholar 

  44. Pollick C (1982) Muscular subaortic stenosis. Hemodynamic and clinical improvement after disopyramide. N Eng J Med 307: 997–999

    Article  CAS  Google Scholar 

  45. Pollick C, Kimball B, Henderson M, Wigle ED (1988) Disopyramide in hypertrophic cardiomyopathy I. Hemodynamic assessment after intravenous administration. Am J Cardiol 62: 1248–1251

    Article  PubMed  CAS  Google Scholar 

  46. Wigle ED, Chrysohou A, Bigelow W (1963) Results of ventriculomyotomy in muscular subaortic stenosis. Am J Cardiol 11: 572–586

    Article  PubMed  CAS  Google Scholar 

  47. Bigelow WG, Trimble AS, Wigle ED, Adelman AG, Felderhof C (1974) The treatment of muscular subaortic stenosis. Thorac Cardiovasc Surg 68: 384–392

    CAS  Google Scholar 

  48. Williams WG, Wigle ED, Rakowski H, Smallhorn J, Le Blanc J, Trusler GA (1987) Results of surgery for idiopathic hypertrophic obstructive cardiomyopathy (IHSS). Circulation 76-II: 104–108

    Google Scholar 

  49. McKenna WJ, England D, Doi YL, Deanfiled JE, Oakley C, Goodwin JF (1981) Arrhythmia in hypertrophic cardiomyopathy I. Influence on prognosis. Br Heart J 46: 168–172

    Article  PubMed  CAS  Google Scholar 

  50. Shah PM, Adelman AG, Wigle ED et al (1975) The natural (and unnatural) history of hypertrophic obstructive cardiomyopathy. Circ Res 34, 35 (Suppl 2): 179–186

    Google Scholar 

  51. Maron BJ, Epstein SE, Morrow AG (1983) Symptomatic status and prognosis of patients after operation for hypertrophic obstructive cardiomyopathy and myectomy. Eur Heart J 4 (Suppl F): 175–185

    PubMed  Google Scholar 

  52. Beahrs MM, Tajak AJ, Seward JB et al (1983) Hypertrophic obstructive cardiomyopathy: 10–21 year follow-up after partial septal myectomy. Am J Cardiol 51: 1160–1166

    Article  PubMed  CAS  Google Scholar 

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Authors
  1. E. D. Wigle
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  2. W. G. Williams
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  3. B. Kimball
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  4. Z. Sasson
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  5. H. Rakowski
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Editor information

Editors and Affiliations

  1. Istituto Fisiologia Clinica CNR, Dipartimento di Cardiologia A. De Gasperis, Ospedale Niguarda, Ca’ Granda, Piazza Ospedale Maggiore 3, 20612, Milan, Italy

    G. Baroldi M.D.

  2. Dipartimento di Cardiologia, Ospedale Maggiore, Piazza Ospedale 1, 34129, Trieste, Italy

    F. Camerini M.D.

  3. 2 Pine Grove, Lake Road, SW19 7HE, Wimbledon, London, UK

    J. F. Goodwin M.D.

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© 1990 Springer-Verlag Berlin Heidelberg

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Wigle, E.D., Williams, W.G., Kimball, B., Sasson, Z., Rakowski, H. (1990). Rational Choice of Medical and/or Surgical Therapy in Hypertrophic Cardiomyopathy. In: Baroldi, G., Camerini, F., Goodwin, J.F. (eds) Advances in Cardiomyopathies. Springer, Berlin, Heidelberg. https://doi.org/10.1007/978-3-642-83760-9_15

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  • DOI: https://doi.org/10.1007/978-3-642-83760-9_15

  • Publisher Name: Springer, Berlin, Heidelberg

  • Print ISBN: 978-3-642-83762-3

  • Online ISBN: 978-3-642-83760-9

  • eBook Packages: Springer Book Archive

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