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Ommen SR, Ho CY, Asif IM, Balaji S, Burke MA, Day SM, Dearani JA, Epps KC, Evanovich L, Ferrari VA, Joglar JA, Khan SS, Kim JJ, Kittleson MM, Krittanawong C, Martinez MW, Mital S, Naidu SS, Saberi S, Semsarian C, Times S, Waldman CB. 2024 AHA/ACC/AMSSM/HRS/PACES/SCMR Guideline for the Management of Hypertrophic Cardiomyopathy: A Report of the American Heart Association/American College of Cardiology Joint Committee on Clinical Practice Guidelines. J Am Coll Cardiol 2024; 83:2324-2405. [PMID: 38727647 DOI: 10.1016/j.jacc.2024.02.014] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 05/20/2024]
Abstract
AIM The "2024 AHA/ACC/AMSSM/HRS/PACES/SCMR Guideline for the Management of Hypertrophic Cardiomyopathy" provides recommendations to guide clinicians in the management of patients with hypertrophic cardiomyopathy. METHODS A comprehensive literature search was conducted from September 14, 2022, to November 22, 2022, encompassing studies, reviews, and other evidence on human subjects that were published in English from PubMed, EMBASE, the Cochrane Library, the Agency for Healthcare Research and Quality, and other selected databases relevant to this guideline. Additional relevant studies, published through May 23, 2023, during the guideline writing process, were also considered by the writing committee and added to the evidence tables, where appropriate. STRUCTURE Hypertrophic cardiomyopathy remains a common genetic heart disease reported in populations globally. Recommendations from the "2020 AHA/ACC Guideline for the Diagnosis and Treatment of Patients With Hypertrophic Cardiomyopathy" have been updated with new evidence to guide clinicians.
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Ommen SR, Ho CY, Asif IM, Balaji S, Burke MA, Day SM, Dearani JA, Epps KC, Evanovich L, Ferrari VA, Joglar JA, Khan SS, Kim JJ, Kittleson MM, Krittanawong C, Martinez MW, Mital S, Naidu SS, Saberi S, Semsarian C, Times S, Waldman CB. 2024 AHA/ACC/AMSSM/HRS/PACES/SCMR Guideline for the Management of Hypertrophic Cardiomyopathy: A Report of the American Heart Association/American College of Cardiology Joint Committee on Clinical Practice Guidelines. Circulation 2024; 149:e1239-e1311. [PMID: 38718139 DOI: 10.1161/cir.0000000000001250] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 06/05/2024]
Abstract
AIM The "2024 AHA/ACC/AMSSM/HRS/PACES/SCMR Guideline for the Management of Hypertrophic Cardiomyopathy" provides recommendations to guide clinicians in the management of patients with hypertrophic cardiomyopathy. METHODS A comprehensive literature search was conducted from September 14, 2022, to November 22, 2022, encompassing studies, reviews, and other evidence on human subjects that were published in English from PubMed, EMBASE, the Cochrane Library, the Agency for Healthcare Research and Quality, and other selected databases relevant to this guideline. Additional relevant studies, published through May 23, 2023, during the guideline writing process, were also considered by the writing committee and added to the evidence tables, where appropriate. STRUCTURE Hypertrophic cardiomyopathy remains a common genetic heart disease reported in populations globally. Recommendations from the "2020 AHA/ACC Guideline for the Diagnosis and Treatment of Patients With Hypertrophic Cardiomyopathy" have been updated with new evidence to guide clinicians.
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Affiliation(s)
| | | | | | | | | | | | | | | | | | - Victor A Ferrari
- AHA/ACC Joint Committee on Clinical Practice Guidelines liaison
- SCMR representative
| | | | - Sadiya S Khan
- ACC/AHA Joint Committee on Performance Measures representative
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Karapanagiotidis GT, Anastasakis E, Nana C, Gukop PS, Zakkar M, Tossios P, Grosomanidis V, Sarridou D, Krimiotis D, Sarsam MAI. Transaortic septal myectomy at the time of aortic valve replacement for severe aortic stenosis: a case series of 55 cases. Indian J Thorac Cardiovasc Surg 2024; 40:292-299. [PMID: 38681705 PMCID: PMC11045907 DOI: 10.1007/s12055-023-01661-x] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/15/2023] [Revised: 11/19/2023] [Accepted: 11/20/2023] [Indexed: 05/01/2024] Open
Abstract
Introduction Symptomatic aortic valve stenosis (AS) is associated with asymmetric basal septal hypertrophy (ABSH) in 10% of cases. In this cohort, it has been suggested that rectification of the left ventricular outflow tract obstruction (LVOTO) by concomitant septal myectomy (CSM) can improve the results of aortic valve replacement (AVR). Objective This study aims to present the technique of AVR with CSM for severe AS with ABSH and to determine the associated early and late post-operative outcomes. Methods Fifty-five patients were prospectively recruited to undergo AVR with CSM between 2011 and 2021 at two centres. The primary outcomes were mortality within 30 days, incidence of post-operative ventricular septal defects (VSD) and prosthetic valve sizing. The secondary outcomes were in-hospital complications, permanent pacemaker implantation (PPI), survival at 15 months and changes on transthoracic echocardiogram. Results Post-operative mortality was 1.8% and this figure was unchanged at 15-month follow-up. No patients developed a post-operative VSD. Intra-operatively, it was found that in 94.6% cases the direct valve sizing increased by one, when compared to the measurement made before CSM. The indexed effective orifice area (iEOA) was > 85 cm2/m2 in 96.4% and no patients had an iEOA ≤ 0.75 cm2/m2. Four patients (7.3%) required PPI due to complete atrioventricular block. Conclusion AVR with CSM is a simple technique that can be utilised in severe AS with ABSH. There does not appear to be an increase in mortality or incidence of iatrogenic VSDs. Importantly, CSM allows for the implantation of a larger aortic valve compared to measurements made before CSM.
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Affiliation(s)
| | - Evangelos Anastasakis
- Department of Cardiothoracic Surgery, St George’s Hospital, London, UK
- St George’s University of London, London, UK
- Ashford and St Peter’s NHS Foundation Trust, Chertsey, UK
- St George’s Hospital, University of London, London, SW17 0QT UK
| | - Chrysoula Nana
- Department of Cardiothoracic Surgery, St George’s Hospital, London, UK
| | | | - Mustafa Zakkar
- Department of Cardiothoracic Surgery, St George’s Hospital, London, UK
- University Hospital of Leicester NHS Trust, Leicester, UK
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Altibi AM, Sapru A, Ghanem F, Zhao Y, Alani A, Cigarroa J, Nazer B, Song HK, Masri A. Impact of concomitant surgical interventions on outcomes of septal myectomy in obstructive hypertrophic cardiomyopathy. Int J Cardiol 2024; 400:131790. [PMID: 38242508 DOI: 10.1016/j.ijcard.2024.131790] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/18/2023] [Revised: 01/07/2024] [Accepted: 01/14/2024] [Indexed: 01/21/2024]
Abstract
BACKGROUND Septal myectomy (SM) is offered to symptomatic patients with obstructive hypertrophic cardiomyopathy (oHCM) despite medical therapy. Frequently, patients undergo concomitant planned or ad-hoc mitral valve replacement (MVR), aortic valve replacement (SAVR), or coronary artery bypass grafting (CABG). OBJECTIVES We sought to assess characteristics and outcomes of patients with oHCM undergoing concomitant surgical interventions at the time of SM. METHODS The National Readmission Databases were used to identify all SM admissions in the United States (2010-2019). Patients undergoing SM were stratified into: isolated SM (±MV repair), SM + CABG only, SM + MVR, SM + SAVR, and SM + MVR + SAVR. Primary outcomes were in-hospital mortality, in-hospital adverse events, and 30-day readmission. RESULTS 12,063 encounters of patients who underwent SM were included (56.1% isolated SM, 9.0% SM + CABG only, 17.5% SM + MVR, 13.1% SM + SAVR, and 4.3% SM + MVR + SAVR). Patients who underwent isolated SM were younger (54.3 vs. 67.1 years-old, p < 0.01) and had lower overall comorbidity burden. In-hospital mortality was lowest in isolated SM, followed by CABG only, SM + SAVR, SM + MVR, and SM + SAVR+MVR groups (2.3% vs. 3.7% vs. 5.3% vs. 6.7% vs. 13.7%, p < 0.01), respectively. SM with combined surgical interventions was associated with higher adverse in-hospital events (24.3% vs. 11.1%, p < 0.01) and 30-day readmissions (16.9% vs. 10.4%, p < 0.01). MV repair performed concomitantly with SM was not associated with increased in-hospital mortality (3.9% vs. 3.4%, p = 0.72; aOR 0.99; 95% CI: 0.54-1.80, p = 0.97]) or adverse clinical events. CONCLUSIONS In SM for oHCM, patients undergoing concomitant surgical interventions were characteristically distinct. Aside from MV repair, concomitant interventions were associated with worse in-hospital death, adverse in-hospital events, and 30-day readmission.
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Affiliation(s)
- Ahmed M Altibi
- Hypertrophic Cardiomyopathy Center, Division of Cardiology, Knight Cardiovascular Institute, Oregon Health and Science University, Portland, OR, United States of America
| | - Abharika Sapru
- Hypertrophic Cardiomyopathy Center, Division of Cardiology, Knight Cardiovascular Institute, Oregon Health and Science University, Portland, OR, United States of America
| | - Fares Ghanem
- Internal Medicine Department, East Tennessee State University, Johnson City, TN, United States of America
| | - Yuanzi Zhao
- Hypertrophic Cardiomyopathy Center, Division of Cardiology, Knight Cardiovascular Institute, Oregon Health and Science University, Portland, OR, United States of America
| | - Ahmad Alani
- Hypertrophic Cardiomyopathy Center, Division of Cardiology, Knight Cardiovascular Institute, Oregon Health and Science University, Portland, OR, United States of America
| | - Joaquin Cigarroa
- Hypertrophic Cardiomyopathy Center, Division of Cardiology, Knight Cardiovascular Institute, Oregon Health and Science University, Portland, OR, United States of America
| | - Babak Nazer
- Division of Cardiovascular Medicine, University of Washington Medical Center, Seattle, WA, United States of America
| | - Howard K Song
- Division of Cardiothoracic Surgery, Knight Cardiovascular Institute, Oregon Health and Science University, Portland, OR, United States of America
| | - Ahmad Masri
- Hypertrophic Cardiomyopathy Center, Division of Cardiology, Knight Cardiovascular Institute, Oregon Health and Science University, Portland, OR, United States of America.
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Moreno M, Ji W, Yee B, Lei K, Ahsan C. Complete Heart Block After Aortic Valve Repair and Septal Myectomy in a Patient With Rheumatic Heart Disease. Cureus 2024; 16:e53347. [PMID: 38435860 PMCID: PMC10907803 DOI: 10.7759/cureus.53347] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 01/31/2024] [Indexed: 03/05/2024] Open
Abstract
Surgical myectomy with concomitant valvular repair has been demonstrated to be safe in the treatment of hypertrophic obstructive cardiomyopathy (HOCM). It is unclear which risk factors predispose patients to develop complete heart block (CHB). We present a unique case of a 66-year-old female with rheumatic heart disease and HOCM admitted for aortic valve (AV) repair and septal myectomy, complicated by a presentation of complete heart block. The histology slide showed fibrosis of the septum, suggesting atrioventricular conduction disease from rheumatic fever, which likely contributed to her presentation. This case highlights the importance of elucidating the etiology of HOCM before undergoing cardiac surgery to guide postsurgical management and improve clinical outcomes.
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Affiliation(s)
- Marvi Moreno
- Internal Medicine, Kirk Kerkorian School of Medicine at University of Nevada, Las Vegas (UNLV), Las Vegas, USA
| | - Wilbur Ji
- Internal Medicine, University of California, San Francisco, San Francisco, USA
| | - Brianna Yee
- Internal Medicine, Kirk Kerkorian School of Medicine at University of Nevada, Las Vegas (UNLV), Las Vegas, USA
| | - Kachon Lei
- Cardiology, Kirk Kerkorian School of Medicine at University of Nevada, Las Vegas (UNLV), Las Vegas, USA
| | - Chowdhury Ahsan
- Internal Medicine and Cardiology, Kirk Kerkorian School of Medicine at University of Nevada, Las Vegas (UNLV), Las Vegas, USA
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Shimahara Y, Honda S, Fujiyoshi T, Kamiya K, Nakano Y, Komatsu I, Yamashita J, Ogino H. Preoperative planning for transaortic septal myectomy using cardiac computed tomography in patients with subaortic septal hypertrophy associated with aortic stenosis: case series. Eur Heart J Case Rep 2023; 7:ytad276. [PMID: 37681057 PMCID: PMC10481893 DOI: 10.1093/ehjcr/ytad276] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/04/2022] [Revised: 01/17/2023] [Accepted: 06/22/2023] [Indexed: 09/09/2023]
Abstract
Background Electrocardiogram-gated cardiac computed tomography (CT) imaging enables a more accurate understanding of the patient's cardiac anatomy. Preoperative planning for transaortic septal myectomy (TASM), based on cardiac CT, may be useful in patients with subaortic septal hypertrophy associated with severe aortic stenosis (AS). Case summary Two elderly patients (age >80 years) with subaortic septal hypertrophy associated with AS underwent surgical aortic valve replacement (SAVR) and concomitant TASM after preoperative planning based on cardiac CT. Both patients showed subaortic septal hypertrophy with blood flow acceleration, left ventricular (LV) hypercontractility, and a short distance from the coaptation point of the mitral valve to the septum, resulting in possible dynamic LV outflow tract (LVOT) obstruction after resolution of AS. Optimal mid-diastolic images, selected from the 70-80% phase, were used for preoperative TASM planning. Planned sizes for myectomy based on multi-planar reconstruction were 10 × 26 × 9 mm (width × length × depth) and 10 × 25 × 9 mm for patient 1 and 2, respectively, while resected tissue size was 10 × 24 × 8 mm and 9 × 24 × 8 mm in patient 1 and 2, respectively. After TASM procedure, SAVR was performed with bioprosthetic valve. Postoperative course of both patients was uneventful with no evidence of complete atrioventricular block, septal perforation, or blood flow acceleration at the LVOT. Discussion Preoperative planning based on cardiac CT images is safe and useful for guiding adequate myectomy and preventing associated complications in patients with subaortic septal hypertrophy associated with AS.
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Affiliation(s)
- Yusuke Shimahara
- Department of Cardiovascular Surgery, Tokyo Medical University, 6-7-1 Nishishinjuku, Shinjuku-ku, Tokyo, 160-0023, Japan
| | - Sayaka Honda
- Department of Cardiovascular Surgery, Tokyo Medical University, 6-7-1 Nishishinjuku, Shinjuku-ku, Tokyo, 160-0023, Japan
| | - Toshiki Fujiyoshi
- Department of Cardiovascular Surgery, Tokyo Medical University, 6-7-1 Nishishinjuku, Shinjuku-ku, Tokyo, 160-0023, Japan
| | - Kentaro Kamiya
- Department of Cardiovascular Surgery, Tokyo Medical University, 6-7-1 Nishishinjuku, Shinjuku-ku, Tokyo, 160-0023, Japan
| | - Yu Nakano
- Department of Cardiovascular Surgery, Tokyo Medical University, 6-7-1 Nishishinjuku, Shinjuku-ku, Tokyo, 160-0023, Japan
| | - Ikki Komatsu
- Department of Cardiology, Tokyo Medical University, Tokyo, Japan
| | - Jun Yamashita
- Department of Cardiology, Tokyo Medical University, Tokyo, Japan
| | - Hitoshi Ogino
- Department of Cardiovascular Surgery, Tokyo Medical University, 6-7-1 Nishishinjuku, Shinjuku-ku, Tokyo, 160-0023, Japan
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7
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UMETSU AKIKO, MATSUSHITA SATOSHI, KINOSHITA TAKESHI, TABATA MINORU. Concomitant Septal Myectomy with Aortic Valve Replacement for Severe Aortic Stenosis with Left Ventricular Outflow Tract Obstruction. JUNTENDO IJI ZASSHI = JUNTENDO MEDICAL JOURNAL 2023; 69:203-215. [PMID: 38855434 PMCID: PMC11153074 DOI: 10.14789/jmj.jmj22-0036-oa] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Subscribe] [Scholar Register] [Received: 10/25/2022] [Accepted: 02/06/2023] [Indexed: 06/11/2024]
Abstract
Objectives Septal myectomy confers survival benefits on patients with hypertrophic cardiomyopathy. However, its role in the treatment of severe aortic stenosis (sAS) with left ventricular outflow tract obstruction (LVOTO) remains under investigation. Another challenging question in the era of transcatheter aortic valve replacement is who would benefit more from traditional surgical aortic valve replacement (SAVR) with myectomy. Therefore, this study aimed to investigate myectomy cases at our hospital in Japan. Methods A total of 740 patients who underwent SAVR for sAS between 2012 and 2019 were identified. The demographics and baseline echocardiographic findings were retrospectively compared between patients who underwent concomitant myectomy and those who did not. The myectomy group was further assessed for factors predisposing to LVOTO, operative details, echocardiographic changes, and prognosis. The resected septa were histopathologically analyzed. Results The myectomy group mostly comprised elderly females with a small hypercontractile heart. Myectomy with SAVR led to statistically significant improvements in concentric left ventricular hypertrophy and LVOTO parameters. Survival was comparable with that reported in previous reports, even in the elderly subset (≥ 75 years). The septa showed mild fibrosis. Conclusions Myectomy can be safely performed with SAVR for sAS with LVOTO, even in the elderly, and it effectively improves LVOTO. Special attention should be paid to elderly females with relatively more severe AS and a small yet extra-hypertrophic and extra-hypercontractile heart. Such patients warrant comprehensive assessment of LVOTO, and despite its invasiveness, SAVR may be potentially more beneficial by allowing direct observation of LVOTO and ancillary myectomy.
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Affiliation(s)
| | - SATOSHI MATSUSHITA
- Corresponding author: Satoshi Matsushita, Department of Cardiovascular Surgery, Juntendo University Graduate School of Medicine, 2-1-1 Hongo, Bunkyo-ku, Tokyo 113-8421, Japan, TEL: +81-3-3813-3111 E-mail:
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8
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Magro PL, Sousa Uva M. What is the role of septal myectomy in aortic stenosis? Rev Port Cardiol 2022; 41:341-346. [DOI: 10.1016/j.repc.2021.02.022] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/01/2021] [Revised: 02/05/2021] [Accepted: 02/17/2021] [Indexed: 10/19/2022] Open
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9
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Bricker RS, Cleveland JC, Messenger JC. Mechanical Complications of Transcatheter Aortic Valve Replacement. Interv Cardiol Clin 2021; 10:465-480. [PMID: 34593110 DOI: 10.1016/j.iccl.2021.06.007] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 06/13/2023]
Abstract
Mechanical complications after transcatheter aortic valve replacement are fortunately rare with the current generation of devices. Unfortunately, life-threatening complications will occur and it is the responsibility of operators to be familiar with strategies to prevent and manage these challenging scenarios. Because these cases will not occur often, it is important for us to highlight and talk about those that do occur, to learn best practices in how to manage and prevent them going forward. We can learn much from each other's good crash landings.
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Affiliation(s)
- Rory S Bricker
- Department of Medicine, Division of Cardiology, University of Colorado School of Medicine, 12631 East 17th Avenue, B130, Aurora, CO 80045, USA
| | - Joseph C Cleveland
- Department of Surgery, Division of Cardiothoracic Surgery, University of Colorado School of Medicine, 12631 East 17th Avenue, 6111, Aurora, CO 80045, USA
| | - John C Messenger
- Department of Medicine, Division of Cardiology, University of Colorado School of Medicine, 12631 East 17th Avenue, B130, Aurora, CO 80045, USA.
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10
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Desai MY, Alashi A, Popovic ZB, Wierup P, Griffin BP, Thamilarasan M, Johnston D, Svensson LG, Lever HM, Smedira NG. Outcomes in Patients With Obstructive Hypertrophic Cardiomyopathy and Concomitant Aortic Stenosis Undergoing Surgical Myectomy and Aortic Valve Replacement. J Am Heart Assoc 2021; 10:e018435. [PMID: 34533040 PMCID: PMC8649531 DOI: 10.1161/jaha.120.018435] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/16/2022]
Abstract
Background Hypertrophic cardiomyopathy (HCM) and aortic stenosis can cause obstruction to the flow of blood out of the left ventricular outflow tract into the aorta, with obstructive HCM resulting in dynamic left ventricular outflow tract obstruction and moderate or severe aortic stenosis causing fixed obstruction caused by calcific degeneration. We sought to report the characteristics and longer-term outcomes of patients with severe obstructive HCM who also had concomitant moderate or severe aortic stenosis requiring surgical myectomy and aortic valve replacement. Methods and Results We studied 191 consecutive patients (age 67±6 years, 52% men) who underwent myectomy and aortic valve (AV) replacement (90% bioprosthesis) at our center between June 2002 and June 2018. Clinical and echo data including left ventricular outflow tract gradient and indexed AV area were recorded. The primary outcome was death. Prevalence of hypertension (63%) and hyperlipidemia (75%) were high, with a Society of Thoracic Surgeons score of 5±4, and 70% of participants had no HCM-related sudden death risk factors. Basal septal thickness and indexed AV area were 1.9±0.4 cm and 0.72±0.2 cm2/m2, respectively, while 100% of patients had dynamic left ventricular outflow tract gradient >50 mm Hg. At 6.5±4 years, 52 (27%) patients died (1.5% in-hospital deaths). One-, 2-, and 5-year survival in the current study sample was 94%, 91%, and 83%, respectively, similar to an age-sex-matched general US population. On multivariate Cox survival analysis, age (hazard ratio [HR], 1.65; 95% CI, 1.24-2.18), chronic kidney disease (HR, 1.58; 95% CI, 1.21-2.32), and right ventricular systolic pressure on preoperative echocardiography (HR, 1.28; 95% CI, 1.05-1.57) were associated with longer-term mortality, but traditional HCM risk factors did not. Conclusions In symptomatic patients with severely obstructive HCM and moderate or severe aortic stenosis undergoing a combined surgical myectomy and AV replacement at our center, the observed postoperative mortality was significantly lower than the expected mortality, and the longer-term survival was similar to a normal age-sex-matched US population.
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Affiliation(s)
- Milind Y Desai
- Hypertrophic Cardiomyopathy and Valve Center Heart and Vascular Institute Cleveland Clinic Cleveland OH
| | - Alaa Alashi
- Hypertrophic Cardiomyopathy and Valve Center Heart and Vascular Institute Cleveland Clinic Cleveland OH
| | - Zoran B Popovic
- Hypertrophic Cardiomyopathy and Valve Center Heart and Vascular Institute Cleveland Clinic Cleveland OH
| | - Per Wierup
- Hypertrophic Cardiomyopathy and Valve Center Heart and Vascular Institute Cleveland Clinic Cleveland OH
| | - Brian P Griffin
- Hypertrophic Cardiomyopathy and Valve Center Heart and Vascular Institute Cleveland Clinic Cleveland OH
| | - Maran Thamilarasan
- Hypertrophic Cardiomyopathy and Valve Center Heart and Vascular Institute Cleveland Clinic Cleveland OH
| | - Douglas Johnston
- Hypertrophic Cardiomyopathy and Valve Center Heart and Vascular Institute Cleveland Clinic Cleveland OH
| | - Lars G Svensson
- Hypertrophic Cardiomyopathy and Valve Center Heart and Vascular Institute Cleveland Clinic Cleveland OH
| | - Harry M Lever
- Hypertrophic Cardiomyopathy and Valve Center Heart and Vascular Institute Cleveland Clinic Cleveland OH
| | - Nicholas G Smedira
- Hypertrophic Cardiomyopathy and Valve Center Heart and Vascular Institute Cleveland Clinic Cleveland OH
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Kitaoka H, Tsutsui H, Kubo T, Ide T, Chikamori T, Fukuda K, Fujino N, Higo T, Isobe M, Kamiya C, Kato S, Kihara Y, Kinugawa K, Kinugawa S, Kogaki S, Komuro I, Hagiwara N, Ono M, Maekawa Y, Makita S, Matsui Y, Matsushima S, Sakata Y, Sawa Y, Shimizu W, Teraoka K, Tsuchihashi-Makaya M, Ishibashi-Ueda H, Watanabe M, Yoshimura M, Fukusima A, Hida S, Hikoso S, Imamura T, Ishida H, Kawai M, Kitagawa T, Kohno T, Kurisu S, Nagata Y, Nakamura M, Morita H, Takano H, Shiga T, Takei Y, Yuasa S, Yamamoto T, Watanabe T, Akasaka T, Doi Y, Kimura T, Kitakaze M, Kosuge M, Takayama M, Tomoike H. JCS/JHFS 2018 Guideline on the Diagnosis and Treatment of Cardiomyopathies. Circ J 2021; 85:1590-1689. [PMID: 34305070 DOI: 10.1253/circj.cj-20-0910] [Citation(s) in RCA: 46] [Impact Index Per Article: 15.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/09/2022]
Affiliation(s)
- Hiroaki Kitaoka
- Department of Cardiology and Geriatrics, Kochi Medical School, Kochi University
| | | | - Toru Kubo
- Department of Cardiology and Geriatrics, Kochi Medical School, Kochi University
| | - Tomomi Ide
- Department of Cardiovascular Medicine, Kyushu University
| | | | - Keiichi Fukuda
- Department of Cardiology, Keio University School of Medicine
| | - Noboru Fujino
- Department of Cardiovascular and Internal Medicine, Kanazawa University, Graduate School of Medical Science
| | - Taiki Higo
- Department of Cardiovascular Medicine, Kyushu University Graduate School of Medical Sciences
| | | | - Chizuko Kamiya
- Department of Perinatology and Gynecology, National Cerebral and Cardiovascular Center
| | - Seiya Kato
- Division of Pathology, Saiseikai Fukuoka General Hospital
| | | | | | | | - Shigetoyo Kogaki
- Department of Pediatrics and Neonatology, Osaka General Medical Center
| | - Issei Komuro
- Department of Cardiovascular Medicine, Graduate School of Medicine, The University of Tokyo
| | | | - Minoru Ono
- Department of Cardiac Surgery, The University of Tokyo Hospital
| | - Yuichiro Maekawa
- Division of Cardiology, Internal Medicine III, Hamamatsu University School of Medicine
| | - Shigeru Makita
- Department of Cardiac Rehabilitation, Saitama International Medical Center, Saitama Medical University
| | - Yoshiro Matsui
- Department of Cardiac Surgery, Hanaoka Seishu Memorial Hospital
| | | | - Yasushi Sakata
- Department of Cardiovascular Medicine, Osaka University Graduate School of Medicine
| | - Yoshiki Sawa
- Department of Cardiovascular Surgery, Osaka University Graduate School of Medicine
| | - Wataru Shimizu
- Department of Cardiovascular Medicine, Nippon Medical School
| | | | | | | | - Masafumi Watanabe
- Department of Cardiology, Pulmonology, and Nephrology, Yamagata University Faculty of Medicine
| | - Michihiro Yoshimura
- Division of Cardiology, Department of Internal Medicine, The Jikei University School of Medicine
| | | | - Satoshi Hida
- Department of Cardiovascular Medicine, Tokyo Medical University
| | - Shungo Hikoso
- Department of Cardiovascular Medicine, Osaka University Graduate School of Medicine
| | | | | | - Makoto Kawai
- Division of Cardiology, Department of Internal Medicine, The Jikei University School of Medicine
| | - Toshiro Kitagawa
- Department of Cardiovascular Medicine, Hiroshima University Graduate School of Biomedical and Health Sciences
| | - Takashi Kohno
- Department of Cardiovascular Medicine, Kyorin University School of Medicine
| | - Satoshi Kurisu
- Department of Cardiovascular Medicine, Hiroshima University Graduate School of Biomedical and Health Sciences
| | - Yoji Nagata
- Division of Cardiology, Fukui CardioVascular Center
| | - Makiko Nakamura
- Second Department of Internal Medicine, University of Toyama
| | - Hiroyuki Morita
- Department of Cardiovascular Medicine, Graduate School of Medicine, The University of Tokyo
| | - Hitoshi Takano
- Department of Cardiovascular Medicine, Nippon Medical School Hospital
| | - Tsuyoshi Shiga
- Department of Clinical Pharmacology and Therapeutics, The Jikei University School of Medicine
| | | | - Shinsuke Yuasa
- Department of Cardiology, Keio University School of Medicine
| | - Teppei Yamamoto
- Department of Cardiovascular Medicine, Nippon Medical School
| | - Tetsu Watanabe
- Department of Cardiology, Pulmonology, and Nephrology, Yamagata University Faculty of Medicine
| | - Takashi Akasaka
- Department of Cardiovascular Medicine, Wakayama Medical University
| | | | - Takeshi Kimura
- Department of Cardiovascular Medicine, Kyoto University Graduate School of Medicine
| | | | - Masami Kosuge
- Division of Cardiology, Yokohama City University Medical Center
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Ommen SR, Mital S, Burke MA, Day SM, Deswal A, Elliott P, Evanovich LL, Hung J, Joglar JA, Kantor P, Kimmelstiel C, Kittleson M, Link MS, Maron MS, Martinez MW, Miyake CY, Schaff HV, Semsarian C, Sorajja P, O'Gara PT, Beckman JA, Levine GN, Al-Khatib SM, Armbruster A, Birtcher KK, Ciggaroa J, Dixon DL, de Las Fuentes L, Deswal A, Fleisher LA, Gentile F, Goldberger ZD, Gorenek B, Haynes N, Hernandez AF, Hlatky MA, Joglar JA, Jones WS, Marine JE, Mark D, Palaniappan L, Piano MR, Tamis-Holland J, Wijeysundera DN, Woo YJ. 2020 AHA/ACC guideline for the diagnosis and treatment of patients with hypertrophic cardiomyopathy: A report of the American College of Cardiology/American Heart Association Joint Committee on Clinical Practice Guidelines. J Thorac Cardiovasc Surg 2021; 162:e23-e106. [PMID: 33926766 DOI: 10.1016/j.jtcvs.2021.04.001] [Citation(s) in RCA: 25] [Impact Index Per Article: 8.3] [Reference Citation Analysis] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/13/2022]
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13
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Qintar M, Villablanca P, Lee J, Wang DD, Frisoli T, O’Neill B, Eng MH, O’Neill WW. Emergency Alcohol Septal Ablation for Shock After TAVR: One More Option in the Toolbox. JACC Case Rep 2021; 3:853-858. [PMID: 34317641 PMCID: PMC8311368 DOI: 10.1016/j.jaccas.2021.03.028] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/20/2021] [Revised: 03/08/2021] [Accepted: 03/24/2021] [Indexed: 11/18/2022]
Abstract
We hereby report a case of severe shock from left ventricular outflow tract obstruction following transcatheter aortic valve replacement that did not respond to medical therapy and had to be treated with emergent alcohol septal ablation (ASA). Emergent ASA should be considered for bail-out treatment for these refractory cases. (Level of Difficulty: Advanced.)
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Affiliation(s)
- Mohammed Qintar
- Address for correspondence: Dr. Mohammed Qintar, Henry Ford Hospital, Center for Structural Heart Disease, 2799 West Grand Boulevard, Clara Ford Pavilion, 4th Floor, Detroit, Michigan 48202, USA.
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14
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Ji Q, Wang Y, Yang Y, Lai H, Ding W, Xia L, Wang C. Surgical Septal Myectomy for the Treatment of Residual Left Ventricular Outflow Tract Obstruction Following Failed Alcohol Septal Ablation. Int Heart J 2021; 62:329-336. [PMID: 33731518 DOI: 10.1536/ihj.20-428] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/18/2022]
Abstract
The reasons of residual left ventricular outflow tract (LVOT) obstruction following alcohol septal ablation (ASA) remain unclear, and outcomes of myectomy following failed ASA remain underreported.Thirteen symptomatic patients (10 women, a median age of 60.0 years) who underwent septal myectomy following failed ASA were reviewed. The patients were followed up for a median of 6 months. The clinical characteristics and outcomes of these patients were analyzed and were compared with those of 178 patients who underwent isolated myectomy without previous ASA at our institution during the same period.In the first ASA procedure, the median number of septal perforator arteries injected was 1.0 with the median value of peak creatine kinase following ablation of 978.5 U/L.Uncontrollable extent and location of infarcted myocardium caused by ablation and mitral subvalvular anomalies were found in four (30.8%) and seven (53.8%) patients, respectively. No operative or follow-up deaths occurred. The median maximum LVOT gradients fell from preoperative 112.0 to 8.5 mmHg at follow-up (P < 0.001). Compared with controls, patients with failed ASA had a higher proportion of mitral subvalvular anomalies (53.8% versus 13.5%, P = 0.001) and developed a higher incidence of complete atrioventricular block following myectomy (15.4% versus 1.7%, P = 0.038).Low institutional or operator experience with ablation, uncontrollable extent and location of infarcted myocardium caused by ablation, and mitral subvalvular anomalies may be reasons for failed ASA. Surgical myectomy for the treatment of residual LVOT obstruction after unsuccessful ASA may be associated with favorable results.
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Affiliation(s)
- Qiang Ji
- Department of Cardiovascular Surgery of Zhongshan Hospital Fudan University
| | - YuLin Wang
- Department of Cardiovascular Surgery of Zhongshan Hospital Fudan University
| | - Ye Yang
- Department of Cardiovascular Surgery of Zhongshan Hospital Fudan University
| | - Hao Lai
- Department of Cardiovascular Surgery of Zhongshan Hospital Fudan University
| | - WenJun Ding
- Department of Cardiovascular Surgery of Zhongshan Hospital Fudan University
| | - LiMin Xia
- Department of Cardiovascular Surgery of Zhongshan Hospital Fudan University.,Department of Cardiovascular Surgery of Xiamen Branch of Zhongshan Hospital Fudan University
| | - ChunSheng Wang
- Shanghai Municipal Institute for Cardiovascular Diseases
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15
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Al Ayouby A, Gilard M, Hebert T, Didier R. Case report: iatrogenic left ventricular outflow tract to right atrium fistula after trans-femoral transcatheter aortic valve implantation associated with asymmetric septal hypertrophy. EUROPEAN HEART JOURNAL-CASE REPORTS 2021; 5:ytab020. [PMID: 34109289 PMCID: PMC8184267 DOI: 10.1093/ehjcr/ytab020] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 09/18/2020] [Revised: 10/07/2020] [Accepted: 12/30/2020] [Indexed: 11/20/2022]
Abstract
Background The transcatheter aortic valve implantation (TAVI) is becoming a leading treatment
option for symptomatic aortic stenosis for patients in all surgical risk categories.
Recognition and management of potential complications are essential to ensure patient
life and comfort. We present here a case report of a left ventricular outflow tract
(LVOT) to right atrium (RA) fistula which is an extremely rare complication after
TAVI. Case summary An 85-year-old man with symptomatic severe aortic stenosis and non-obstructive
asymmetric septal hypertrophy (ASH) underwent a transfemoral TAVI. Soon after the
procedure, he developed chest pain and atrial fibrillation with rapid ventricular
response. A transthoracic echocardiography followed by a transoesophageal
echocardiography showed a small pseudo-aneurysm with a fistulous tract between the LVOT
and the RA. This was confirmed by a contrast computed tomography scan of the heart. The
patient remained asymptomatic throughout the rest of hospitalization. He was treated
with diuretics and discharged home. One month follow-up showed increase in the width,
jet size, and gradient of the fistula but the patient remained asymptomatic. The
decision by Heart team was to closely monitor him for symptoms since the fistula is
difficult to access percutaneously. Discussion We report a unique case of an LVOT to RA fistula in the setting of ASH that occurred
post-TAVI. Alcohol septal ablation was proposed pre-TAVI for patients having septal
thickening >15 mm and dynamic obstruction. Treatment options for iatrogenic fistula
vary from symptomatic treatment to percutaneous or surgical closure.
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Affiliation(s)
- Ahmad Al Ayouby
- Department of Cardiology, University Hospital of Brest, Tanguy Prigent Boulevard, 29609 Brest Cedex, France
| | - Martine Gilard
- Department of Cardiology, University Hospital of Brest, Tanguy Prigent Boulevard, 29609 Brest Cedex, France
| | - Thomas Hebert
- Department of Radiology, University Hospital of Brest, Tanguy Prigent Boulevard, 29609 Brest Cedex, France
| | - Romain Didier
- Department of Cardiology, University Hospital of Brest, Tanguy Prigent Boulevard, 29609 Brest Cedex, France
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16
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Aortic root widening: “pro et contra”. Indian J Thorac Cardiovasc Surg 2021; 38:91-100. [PMID: 35463701 PMCID: PMC8980977 DOI: 10.1007/s12055-020-01125-6] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/27/2020] [Revised: 12/12/2020] [Accepted: 12/16/2020] [Indexed: 10/22/2022] Open
Abstract
In patients with a small aortic annulus, the clinical benefits of aortic valve replacement depend on avoidance of patient-prosthesis mismatch as it is associated with reduced overall survival. Aortic root widening or enlargement is a useful technique to implant larger valve prosthesis to prevent patient-prosthesis mismatch. Posterior annular enlargement is the commonest technique used for aortic root enlargement. Consistent enlargement of the aortic root requires more extensive procedures like Manouguian or Konno-Rastan techniques. The patients commonly selected are younger patients with good life expectancy. However, caution is advised in applying this procedure in elderly patients, patients with heavily calcified annulus and when performing concomitant procedures. There is no definitive conclusion on the best material to use for the reconstruction of aortic annulus and aorta in aortic root enlargement procedures.
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17
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Endo N, Otsuki H, Domoto S, Yamaguchi J. Haemodynamic collapse immediately after transcatheter aortic valve implantation due to dynamic intraventricular gradient: a case report and review of the literature. EUROPEAN HEART JOURNAL-CASE REPORTS 2021; 5:ytaa565. [PMID: 33598628 PMCID: PMC7873795 DOI: 10.1093/ehjcr/ytaa565] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 05/27/2020] [Revised: 07/28/2020] [Accepted: 12/17/2020] [Indexed: 11/13/2022]
Abstract
Background Dynamic intraventricular obstruction after transcatheter aortic valve implantation (TAVI) has been previously reported. There is a risk of haemodynamic collapse in the case of left ventricular outflow tract (LVOT) obstruction due to systolic anterior motion (SAM) of the mitral valve. Case summary An 83-year-old woman with aortic stenosis (AS) was referred to our hospital for TAVI. Transthoracic echocardiography revealed a severely calcified aortic valve with a peak velocity of 6.3 m/s across the valve. Acceleration of blood flow (peak velocity 2.6 m/s) at the LVOT due to a septal bulge was also seen. Transfemoral TAVI was performed, and a 29 mm Evolut PRO was implanted under general anaesthesia. After the implantation, a complete atrioventricular block with junctional rhythm developed, and refractory hypotension occurred immediately. Transoesophageal echocardiography revealed LVOT obstruction due to SAM of the mitral valve associated with severe mitral regurgitation (MR), which was not observed preoperatively. Fluid infusion and catecholamine administration were not effective. However, after performing temporary pacing from the right ventricular (RV) apex, the LVOT obstruction and severe MR improved. Her haemodynamics stabilized, and we could complete the procedure. A dual-chamber permanent pacemaker with beta-blocker administration as a longer-term treatment further improved the LVOT obstruction. The patient was finally discharged to a rehabilitation hospital. Discussion Alertness and recognition of potential LVOT obstruction after TAVI are important. Pacing from the RV apex, as well as dual-chamber pacing, comprise a less invasive and feasible therapeutic option in such cases.
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Affiliation(s)
- Nana Endo
- Department of Cardiology, Tokyo Women's Medical University, 8-1 Kawada-cho, Shinjuku-ku, Tokyo 162-0054, Japan
| | - Hisao Otsuki
- Department of Cardiology, Tokyo Women's Medical University, 8-1 Kawada-cho, Shinjuku-ku, Tokyo 162-0054, Japan
| | - Satoru Domoto
- Department of Cardiovascular Surgery, Tokyo Women's Medical University, 8-1 Kawada-cho, Shinjuku-ku, Tokyo 162-0054, Japan
| | - Junichi Yamaguchi
- Department of Cardiology, Tokyo Women's Medical University, 8-1 Kawada-cho, Shinjuku-ku, Tokyo 162-0054, Japan
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18
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Ommen SR, Mital S, Burke MA, Day SM, Deswal A, Elliott P, Evanovich LL, Hung J, Joglar JA, Kantor P, Kimmelstiel C, Kittleson M, Link MS, Maron MS, Martinez MW, Miyake CY, Schaff HV, Semsarian C, Sorajja P. 2020 AHA/ACC Guideline for the Diagnosis and Treatment of Patients With Hypertrophic Cardiomyopathy: Executive Summary: A Report of the American College of Cardiology/American Heart Association Joint Committee on Clinical Practice Guidelines. J Am Coll Cardiol 2020; 76:3022-3055. [PMID: 33229115 DOI: 10.1016/j.jacc.2020.08.044] [Citation(s) in RCA: 127] [Impact Index Per Article: 31.8] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/21/2022]
Abstract
AIM This executive summary of the hypertrophic cardiomyopathy clinical practice guideline provides recommendations and algorithms for clinicians to diagnose and manage hypertrophic cardiomyopathy in adult and pediatric patients as well as supporting documentation to encourage their use. METHODS A comprehensive literature search was conducted from January 1, 2010, to April 30, 2020, encompassing studies, reviews, and other evidence conducted on human subjects that were published in English from PubMed, EMBASE, the Cochrane Collaboration, Agency for Healthcare Research and Quality reports, and other relevant databases. STRUCTURE Many recommendations from the earlier hypertrophic cardiomyopathy guidelines have been updated with new evidence or a better understanding of earlier evidence. This summary operationalizes the recommendations from the full guideline and presents a combination of diagnostic work-up, genetic and family screening, risk stratification approaches, lifestyle modifications, surgical and catheter interventions, and medications that constitute components of guideline directed medical therapy. For both guideline-directed medical therapy and other recommended drug treatment regimens, the reader is advised to follow dosing, contraindications and drug-drug interactions based on product insert materials.
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19
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Ommen SR, Mital S, Burke MA, Day SM, Deswal A, Elliott P, Evanovich LL, Hung J, Joglar JA, Kantor P, Kimmelstiel C, Kittleson M, Link MS, Maron MS, Martinez MW, Miyake CY, Schaff HV, Semsarian C, Sorajja P. 2020 AHA/ACC Guideline for the Diagnosis and Treatment of Patients With Hypertrophic Cardiomyopathy: Executive Summary: A Report of the American College of Cardiology/American Heart Association Joint Committee on Clinical Practice Guidelines. Circulation 2020; 142:e533-e557. [PMID: 33215938 DOI: 10.1161/cir.0000000000000938] [Citation(s) in RCA: 103] [Impact Index Per Article: 25.8] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/21/2022]
Abstract
Aim This executive summary of the hypertrophic cardiomyopathy clinical practice guideline provides recommendations and algorithms for clinicians to diagnose and manage hypertrophic cardiomyopathy in adult and pediatric patients as well as supporting documentation to encourage their use. Methods A comprehensive literature search was conducted from January 1, 2010, to April 30, 2020, encompassing studies, reviews, and other evidence conducted on human subjects that were published in English from PubMed, EMBASE, the Cochrane Collaboration, Agency for Healthcare Research and Quality reports, and other relevant databases. Structure Many recommendations from the earlier hypertrophic cardiomyopathy guidelines have been updated with new evidence or a better understanding of earlier evidence. This summary operationalizes the recommendations from the full guideline and presents a combination of diagnostic work-up, genetic and family screening, risk stratification approaches, lifestyle modifications, surgical and catheter interventions, and medications that constitute components of guideline directed medical therapy. For both guideline-directed medical therapy and other recommended drug treatment regimens, the reader is advised to follow dosing, contraindications and drug-drug interactions based on product insert materials.
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Affiliation(s)
| | | | | | | | - Anita Deswal
- ACC/AHA Joint Committee on Clinical Practice Guidelines Liaison
- HFSA Representative
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20
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Ommen SR, Mital S, Burke MA, Day SM, Deswal A, Elliott P, Evanovich LL, Hung J, Joglar JA, Kantor P, Kimmelstiel C, Kittleson M, Link MS, Maron MS, Martinez MW, Miyake CY, Schaff HV, Semsarian C, Sorajja P. 2020 AHA/ACC Guideline for the Diagnosis and Treatment of Patients With Hypertrophic Cardiomyopathy: A Report of the American College of Cardiology/American Heart Association Joint Committee on Clinical Practice Guidelines. J Am Coll Cardiol 2020; 76:e159-e240. [PMID: 33229116 DOI: 10.1016/j.jacc.2020.08.045] [Citation(s) in RCA: 342] [Impact Index Per Article: 85.5] [Reference Citation Analysis] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/22/2022]
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21
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Ommen SR, Mital S, Burke MA, Day SM, Deswal A, Elliott P, Evanovich LL, Hung J, Joglar JA, Kantor P, Kimmelstiel C, Kittleson M, Link MS, Maron MS, Martinez MW, Miyake CY, Schaff HV, Semsarian C, Sorajja P. 2020 AHA/ACC Guideline for the Diagnosis and Treatment of Patients With Hypertrophic Cardiomyopathy. Circulation 2020; 142:e558-e631. [DOI: 10.1161/cir.0000000000000937] [Citation(s) in RCA: 81] [Impact Index Per Article: 20.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/20/2022]
Affiliation(s)
| | | | | | | | | | - Anita Deswal
- ACC/AHA Joint Committee on Clinical Practice Guidelines Liaison
- HFSA Representative
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22
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Mathew J, Dearani JA, Daly RC, Schaff HV. Management of Subaortic Left Ventricular Outflow Tract Obstruction After Aortic Valve Replacement. Ann Thorac Surg 2020; 112:1468-1473. [PMID: 33333082 DOI: 10.1016/j.athoracsur.2020.11.024] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/25/2020] [Revised: 09/21/2020] [Accepted: 11/30/2020] [Indexed: 01/21/2023]
Abstract
BACKGROUND Residual or new left ventricular outflow tract (LVOT) obstruction after an aortic valve replacement poses special challenges with respect to operative techniques. Our study assesses this gap. METHODS From January 1993 to May 2019, 18 patients underwent a septal myectomy at Mayo Clinic for subaortic obstruction after aortic valve replacement. We evaluated their demographics, clinical presentation, and echocardiograms, and the type of prior valve replacement, need for repeat replacement, and their short- and long-term outcomes. The data were analyzed using descriptive statistics. RESULTS All patients underwent septal myectomy for LVOT obstruction at a median interval of 7 years (interquartile range, 3-15 years) from their prior aortic valve procedure. Preoperatively, the median left ventricular outflow tract gradient was 57 mm Hg (interquartile range, 44-77 mm Hg); 10 patients (55.5%) had systolic anterior motion (SAM) of the mitral leaflets. Repeat replacement of the aortic valve at the time of myectomy was needed in 14 patients, and septal myectomy alone was performed in 4 patients. One hospital death occurred 34 days after myectomy and aortic valve replacement, and 2 patients needed permanent pacemaker placement for complete heart block. CONCLUSIONS Septal myectomy after aortic valve replacement may be performed with repeat replacement of the valve, if there is coexisting prosthetic dysfunction, through a normally functioning bioprosthesis or through an apical approach when visualization through the aortic prosthesis is poor. The complexity of reoperation supports a liberal approach to myectomy at the time of aortic valve replacement when there is significant subaortic septal hypertrophy.
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Affiliation(s)
- Jessey Mathew
- Department of Cardiovascular Surgery, Mayo Clinic, Rochester, Minnesota
| | - Joseph A Dearani
- Department of Cardiovascular Surgery, Mayo Clinic, Rochester, Minnesota
| | - Richard C Daly
- Department of Cardiovascular Surgery, Mayo Clinic, Rochester, Minnesota
| | - Hartzell V Schaff
- Department of Cardiovascular Surgery, Mayo Clinic, Rochester, Minnesota.
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23
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Novén J, Stagmo M, Wierup P, Nozohoor S, Bjursten H, Sjögren J, Zindovic I, Ragnarsson S. Exercise Echocardiography following Septal Myectomy for Hypertrophic Obstructive Cardiomyopathy. Thorac Cardiovasc Surg 2020; 70:18-25. [PMID: 33225436 DOI: 10.1055/s-0040-1716896] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/22/2022]
Abstract
OBJECTIVES To investigate outcome after septal myectomy and to evaluate long-term hemodynamics with exercise echocardiography. METHODS This study included 40 consecutive patients operated with septal myectomy for hypertrophic obstructive cardiomyopathy from January 1998 to August 2017 at Skane University Hospital, Lund, Sweden. Perioperative clinical data and echocardiography measurements were reviewed retrospectively. Patients (n = 36) who were alive and living in Sweden were invited for exercise echocardiography to evaluate exercise capacity and hemodynamics, of whom 19 patients performed exercise echocardiography. RESULTS Overall survival was 100% at 1 year and 96% at 5 years following surgery. Preoperative median resting peak LVOT (left ventricular outflow tract) gradient was 80 mm Hg. Septum thickness was reduced from 22 ± 4 mm preoperatively to 16 ± 3 mm postoperatively (p < 0.001). During exercise echocardiography, the peak LVOT gradient was 8 mm Hg at rest, and increased to 13 mm Hg during exercise echocardiography (p = 0.002). None of the patients had dynamic LVOT obstruction during exercise echocardiography, and there was no clinically significant systolic anterior motion or severe mitral insufficiency during exercise. CONCLUSIONS Long-term survival following septal myectomy is very good. At long-term follow-up, LVOT gradients were low and exercise echocardiography demonstrated good hemodynamics.
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Affiliation(s)
- Johan Novén
- Department of Cardiothoracic Surgery, Skane University Hospital, Lund University, Lund, Sweden
| | - Martin Stagmo
- Department of Cardiology, Skane University Hospital, Lund University, Lund, Sweden
| | - Per Wierup
- Department of Thoracic and Cardiovascular Surgery, Cleveland Clinic, Cleveland, Ohio, United States
| | - Shahab Nozohoor
- Department of Cardiothoracic Surgery, Skane University Hospital, Lund University, Lund, Sweden
| | - Henrik Bjursten
- Department of Cardiothoracic Surgery, Skane University Hospital, Lund University, Lund, Sweden
| | - Johan Sjögren
- Department of Cardiothoracic Surgery, Skane University Hospital, Lund University, Lund, Sweden
| | - Igor Zindovic
- Department of Cardiothoracic Surgery, Skane University Hospital, Lund University, Lund, Sweden
| | - Sigurdur Ragnarsson
- Department of Cardiothoracic Surgery, Skane University Hospital, Lund University, Lund, Sweden
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24
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von Aspern K, Bianchi E, Haunschild J, Dahlenburg C, Misfeld M, Borger MA, Etz CD. Propensity score matched comparison of isolated, elective aortic valve replacement with and without concomitant septal myectomy: is it worth it? THE JOURNAL OF CARDIOVASCULAR SURGERY 2020; 62:258-267. [PMID: 32885927 DOI: 10.23736/s0021-9509.20.11443-5] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 01/09/2023]
Abstract
BACKGROUND Septal myectomy during open aortic valve replacement (AVR) is an effective surgical treatment for asymmetric secondary basal septal hypertrophy. Concerns regarding higher rates of complications associated with this procedure have been raised - such as permanent pacemaker implantation. The aim of this study was to compare outcomes and complications of patients with and without concomitant septal myectomy using propensity score matching applied to a large, consecutive single center cohort. METHODS A total of 2199 consecutive patients undergoing either AVR with concomitant myectomy (AVR-M, N.=212) or AVR alone (N.=1987) were analyzed (2009-2015). Patients with previous cardiac or emergency surgery, concomitant cardiac procedures and endocarditis were excluded. As reference to previously published data, patient characteristics and outcomes of the overall cohort were examined and for comparison between groups propensity score matching utilized. RESULTS In the unmatched cohort, AVR-M patients were older (71.2±8 vs. 67.6±10 years, P<0.001) and more often female (68% vs. 37%, P<0.001) in comparison to patients receiving only AVR. After matching (N.=374) no significant difference in baseline features was evident. No significant difference in hospital mortality (2.1% vs. 1.6%, P=1.000) and pacemaker-implantation rate (5.3% vs. 3.7%, P=0.621) was observed. Mid-term survival was comparable between the two groups (86.1±5% vs. 84.4±5% after 6 years, P=0.957). The overall patient cohort showed a survival comparable to that of an adjusted regional normal population (P=0.178). CONCLUSIONS This study demonstrates that concomitant myectomy in patients undergoing AVR is a safe surgical technique resulting in comparable hospital mortality and mid-term survival. Concomitant septal myectomy seems not to be associated with an increased pacemaker implantation rate.
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Affiliation(s)
| | - Edoardo Bianchi
- Department of Cardiac Surgery, Heart Center Leipzig, Leipzig, Germany
| | | | | | - Martin Misfeld
- Department of Cardiac Surgery, Heart Center Leipzig, Leipzig, Germany.,Department of Cardiothoracic Surgery, The Royal Prince Alfred Hospital, Sydney, Australia
| | - Michael A Borger
- Department of Cardiac Surgery, Heart Center Leipzig, Leipzig, Germany
| | - Christian D Etz
- Department of Cardiac Surgery, Heart Center Leipzig, Leipzig, Germany -
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25
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Dual-Chamber pacing for postoperative residual left ventricular gradient after aortic valve replacement and concomitant septal myectomy for severe aortic stenosis and subvalvular obstruction. J Cardiol Cases 2020; 22:15-18. [PMID: 32636962 DOI: 10.1016/j.jccase.2020.03.011] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/16/2019] [Revised: 01/21/2020] [Accepted: 03/15/2020] [Indexed: 11/24/2022] Open
Abstract
Background Aortic stenosis is occasionally associated with subvalvular obstruction and remaining obstruction may at times be found after aortic valve replacement. Case report A 69-year-old woman with a history of several episodes of unconsciousness was admitted because of exertional chest oppression. The echocardiography revealed severe aortic stenosis (flow velocity 6.2 m/sec, maximum / mean pressure gradient 152 / 99 mmHg, valve area 0.59 cm2) as well as gradient within the left ventricular cavity from the mid ventricular level (flow velocity 4.5 m/sec, maximum gradient 82 mmHg). Despite aortic valve replacement and concomitant septal myectomy which was thought adequate in reducing subvalvular pressure gradient during surgery, postoperative echocardiography revealed significant residual mid ventricular gradient (flow velocity 4.9 m/sec, maximum gradient 95 mmHg). It was decided to implant dual-chamber pacemaker, which resulted in significant reduction of residual mid ventricular gradient (flow velocity 1.4 m/sec, maximum gradient 8 mmHg). Conclusion Dual-chamber pacing was extremely effective in reducing residual mid ventricular gradient in a patient who underwent aortic valve replacement and concomitant septal myectomy for severe aortic stenosis and subvalvular obstruction.<Learning objective: Dual-chamber pacing was extremely effective in reducing residual mid-ventricular pressure gradient in a 69-year-old woman with antecedent aortic valve replacement and concomitant septal myectomy for severe aortic stenosis and subvalvular obstruction.Dual-chamber pacing may have the potential to become one of the non-surgical therapeutic options for those with post-surgical residual subvalvular gradient, not only for severe aortic stenosis and subvalvular obstruction but also for obstructive hypertrophic cardiomyopathy.>.
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26
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Rowin EJ, Kimmelstiel C. Combined alcohol septal ablation and transcatheter aortic valve replacement: Drunk and playing with fire. Catheter Cardiovasc Interv 2020; 95:838-839. [PMID: 32159290 DOI: 10.1002/ccd.28795] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/10/2020] [Accepted: 02/13/2020] [Indexed: 11/10/2022]
Abstract
Evaluation of the severity of aortic stenosis in the presence of dynamic left ventricular outflow (LVOT) obstruction is challenging. Invasive hemodynamic assessment with provocative maneuvers can be useful to differentiate of the relative components of obstruction. In patients with both dynamic LVOT obstruction and aortic stenosis, surgical myectomy and concurrent surgical aortic valve replacement is the optimal treatment strategy; combined alcohol septal ablation and transcatheter aortic valve replacement should only be considered for very high surgical risk patients.
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Affiliation(s)
- Ethan J Rowin
- Hypertrophic Cardiomyopathy Institute, Tufts Medical Center, Boston, Massachusetts
| | - Carey Kimmelstiel
- Hypertrophic Cardiomyopathy Institute, Tufts Medical Center, Boston, Massachusetts.,Cardiac Catheterization Laboratory, Tufts Medical Center, Boston, Massachusetts
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27
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Surgical Therapy for Patients with Severe Aortic Stenosis in the Era of Transcatheter Aortic Valve Replacement. J UOEH 2019; 41:397-408. [PMID: 31866657 DOI: 10.7888/juoeh.41.397] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/21/2022]
Abstract
Aortic stenosis (AS) is the most common valvular heart disease and is most frequently recognized among elderly people. Surgical aortic valve replacement (SAVR) is the most effective therapy, but its indication is sometimes difficult, and is impossible for high operative risk patients. Transcatheter aortic valve replacement (TAVR) was recently approved in Japan for high risk and inoperable patients with severe AS. TAVR is a less invasive method because it does not require a cardiopulmonary bypass and is associated with excellent surgical outcomes. In Western countries, the indication of TAVR has already been extended to moderate operative risk patients with severe AS, and is going to be further extended to low risk patients. The number of patients undergoing TAVR is increasing progressively, and there are effective alternative therapies for patients with severe AS. Selection of these surgical methods will be important in the near future. In regard to low operative risk patients especially, not only operative mortality, but also long-tern mortality and morbidity and quality of life should be taken into consideration. It is considered that some comorbidities in AS patients will be revealed to have an impact on surgical outcomes at the time when these surgical methods are selected. In this review, we examine end-stage renal disease on hemodialysis, functional tricuspid regurgitation, and sigmoid septum, and give an outline of what influence SAVR and TAVR have on the surgical outcomes of severe AS patients.
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Goel H, Kumar A, Garg N, Mills JD. Men are from mars, women are from venus: Factors responsible for gender differences in outcomes after surgical and trans-catheter aortic valve replacement. Trends Cardiovasc Med 2019; 31:34-46. [PMID: 31902553 DOI: 10.1016/j.tcm.2019.11.010] [Citation(s) in RCA: 15] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/11/2019] [Revised: 11/21/2019] [Accepted: 11/23/2019] [Indexed: 01/09/2023]
Abstract
Females suffer higher operative (30-day) mortality than males after surgical aortic valve replacement (SAVR). In contrast, outcomes after trans-catheter aortic valve replacement (TAVR) seem to favor females, both in terms of procedural mortality, and more prominently, medium to long-term survival. With an ever-greater number of TAVR procedures being performed, an understanding of factors responsible for gender differences in outcomes after the two AVR modalities is critical for better patient selection. Current evidence suggests that this gender difference in outcomes after SAVR and TAVR stems from differences in baseline risk profiles, as well as inherent anatomic/physiological differences between genders. This review attempts to examine these clinical and physiological factors, with a goal of guiding better patient selection for each AVR modality, and to highlight areas that beg further investigation.
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Affiliation(s)
- Harsh Goel
- Department of Medicine, St. Luke's University Hospital, Bethlehem, PA, United States; Lewis Katz School of Medicine, Temple University, Philadelphia, PA, United States.
| | - Ashish Kumar
- Department of Medicine, Wellspan York Hospital, York, PA, United States
| | - Nadish Garg
- Department of Medicine, St Barnabas Medical Center, Livingston, NJ, United States
| | - James D Mills
- Department of Medicine, Division of Cardiovascular Medicine, West Virginia University Heart and Vascular Institute, Morgantown, WV, United States
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Recurrence of Left Ventricular Outflow Tract Obstruction Requiring Alcohol Septal Ablation after Transcatheter Aortic Valve Implantation. Case Rep Cardiol 2018; 2018:5026190. [PMID: 30627448 PMCID: PMC6305023 DOI: 10.1155/2018/5026190] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/19/2018] [Accepted: 10/29/2018] [Indexed: 11/25/2022] Open
Abstract
Left ventricular outflow tract (LVOT) obstruction is sometimes observed in patients with severe aortic stenosis (AS). It is still controversial how to manage the remaining severe AS, when LVOT obstruction is well-controlled by medical therapy. We report a case with acute recurrence of LVOT obstruction requiring emergent alcohol septal ablation (ASA) after transcatheter aortic valve implantation (TAVI), even in a stable state on beta-blockers. For the ASA procedure, transesophageal echocardiography was useful to clearly observe the perfusion area of the target septal branch by injecting microbubble contrast. Since it took some time to cause the recurrence of LVOT obstruction in this case, careful evaluation should be done after TAVI in high-risk patients for LVOT obstruction before terminating the TAVI procedure.
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Yamashita K, Fujita T, Fukushima S, Shimahara Y, Kume Y, Matsumoto Y, Kawamoto N, Minami K, Kabata D, Kanzaki H, Izumi C, Anzai T, Kobayashi J. Transcatheter Aortic Valve Replacement for Severe Aortic Stenosis Complicated by Sigmoid Septum. Circ J 2018; 82:3090-3099. [DOI: 10.1253/circj.cj-18-0264] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/09/2022]
Affiliation(s)
- Kizuku Yamashita
- Department of Cardiac Surgery, National Cerebral and Cardiovascular Center
| | - Tomoyuki Fujita
- Department of Cardiac Surgery, National Cerebral and Cardiovascular Center
| | - Satsuki Fukushima
- Department of Cardiac Surgery, National Cerebral and Cardiovascular Center
| | - Yusuke Shimahara
- Department of Cardiac Surgery, National Cerebral and Cardiovascular Center
| | - Yuta Kume
- Department of Cardiac Surgery, National Cerebral and Cardiovascular Center
| | - Yorihiko Matsumoto
- Department of Cardiac Surgery, National Cerebral and Cardiovascular Center
| | - Naonori Kawamoto
- Department of Cardiac Surgery, National Cerebral and Cardiovascular Center
| | - Kimito Minami
- Department of Surgical Intensive Care, National Cerebral and Cardiovascular Center
- Department of Medical Statistics, Osaka City University Graduate School of Medicine and Faculty of Medicine
| | - Daijiro Kabata
- Department of Medical Statistics, Osaka City University Graduate School of Medicine and Faculty of Medicine
| | - Hideaki Kanzaki
- Department of Cardiovascular Medicine, National Cerebral and Cardiovascular Center
| | - Chisato Izumi
- Department of Cardiovascular Medicine, National Cerebral and Cardiovascular Center
| | - Toshihisa Anzai
- Department of Cardiovascular Medicine, Hokkaido University Graduate School of Medicine
| | - Junjiro Kobayashi
- Department of Cardiac Surgery, National Cerebral and Cardiovascular Center
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Yoshitani H, Isotani A, Song JK, Shirai S, Umeda H, Jang JY, Onoue T, Toki M, Sun BJ, Kim DH, Kagiyama N, Hayashida A, Song JM, Eto M, Nishimura Y, Ando K, Hanyu M, Yoshida K, Levine RA, Otsuji Y. Surgical as Opposed to Transcatheter Aortic Valve Replacement Improves Basal Interventricular Septal Hypertrophy. Circ J 2018; 82:2887-2895. [PMID: 30135322 DOI: 10.1253/circj.cj-18-0390] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/09/2022]
Abstract
BACKGROUND Basal interventricular septum (IVS) hypertrophy (BSH) with reduced basal IVS contraction and IVS-aorta angle is frequently associated with aortic stenosis (AS). BSH shape suggests compression by the longitudinally elongated ascending aorta, causing basal IVS thickening and contractile dysfunction, further suggesting the possibility of aortic wall shortening to improve the BSH. Surgical aortic valve replacement (SAVR), as opposed to transcatheter AVR (TAVR), includes aortic wall shortening by incision and stitching on the wall and may potentially improve BSH. We hypothesized that BSH configuration and its contraction improves after SAVR in patients with AS. Methods and Results: In 32 patients with SAVR and 36 with TAVR for AS, regional wall thickness and systolic contraction (longitudinal strain) of 18 left ventricular (LV) segments, and IVS-aorta angle were measured on echocardiography. After SAVR, basal IVS/average LV wall thickness ratio, basal IVS strain, and IVS-aorta angle significantly improved (1.11±0.24 to 1.06±0.17; -6.2±5.7 to -9.1±5.2%; 115±22 to 123±14°, P<0.001, respectively). Contractile improvement in basal IVS was correlated with pre-SAVR BSH (basal IVS/average LV wall thickness ratio or IVS-aorta angle: r=0.47 and 0.49, P<0.01, respectively). In contrast, BSH indices did not improve after TAVR. CONCLUSIONS In patients with AS, SAVR as opposed to TAVR improves associated BSH and its functional impairment.
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Affiliation(s)
- Hidetoshi Yoshitani
- Second Department of Internal Medicine, University of Occupational and Environmental Health, Japan
| | | | | | | | - Hiromi Umeda
- Department of Echocardiography, Kokura Memorial Hospital
| | | | - Takeshi Onoue
- Second Department of Internal Medicine, University of Occupational and Environmental Health, Japan
| | - Misako Toki
- Department of Clinical Laboratory, The Sakakibara Heart Institution of Okayama
| | | | - Dae-Hee Kim
- Department of Echocardiography, Asan Medical Center
| | - Nobuyuki Kagiyama
- Department of Cardiology, The Sakakibara Heart Institution of Okayama
| | - Akihiro Hayashida
- Department of Cardiology, The Sakakibara Heart Institution of Okayama
| | | | - Masataka Eto
- Department of Cardiovascular Surgery, University of Occupational and Environmental Health, Japan
| | - Yosuke Nishimura
- Department of Cardiovascular Surgery, University of Occupational and Environmental Health, Japan
| | - Kenji Ando
- Department of Cardiology, Kokura Memorial Hospital
| | - Michiya Hanyu
- Department of Cardiovascular Surgery, Kokura Memorial Hospital
| | - Kiyoshi Yoshida
- Department of Cardiology, The Sakakibara Heart Institution of Okayama
| | - Robert A Levine
- Cardiac Ultrasound Laboratory, Massachusetts General Hospital
| | - Yutaka Otsuji
- Second Department of Internal Medicine, University of Occupational and Environmental Health, Japan
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Sigurdsson M, McCartney SL, Maslow A. Dynamic Left Ventricular Outflow Obstruction and Systolic Anterior Motion of the Mitral Valve Complicating Surgical Aortic Valve Replacement. J Cardiothorac Vasc Anesth 2018; 33:863-865. [PMID: 29935803 DOI: 10.1053/j.jvca.2018.05.008] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/03/2018] [Indexed: 11/11/2022]
Affiliation(s)
- Martin Sigurdsson
- Department of Anesthesiology, Divisions of Cardiothoracic and Critical Care Anesthesiology, Duke University, Durham, NC
| | - Sharon L McCartney
- Department of Anesthesiology, Divisions of Cardiothoracic and Critical Care Anesthesiology, Duke University, Durham, NC
| | - Andrew Maslow
- Department of Anesthesiology, Warren Alpert School of Medicine at Brown University, Providence, RI
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33
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Abecasis J, Gouveia R, Castro M, Andrade MJ, Ribeiras R, Ramos S, Abecasis M, Cardim N, Gil V. Surgical pathology of subaortic septal myectomy: histology skips over clinical diagnosis. Cardiovasc Pathol 2018; 33:32-38. [DOI: 10.1016/j.carpath.2017.12.002] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/02/2017] [Revised: 12/17/2017] [Accepted: 12/20/2017] [Indexed: 12/23/2022] Open
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Tsuruta H, Hayashida K, Yashima F, Yanagisawa R, Tanaka M, Arai T, Minakata Y, Itabashi Y, Murata M, Kohsaka S, Maekawa Y, Takahashi T, Yoshitake A, Shimizu H, Fukuda K. Incidence, predictors, and midterm clinical outcomes of left ventricular obstruction after transcatheter aortic valve implantation. Catheter Cardiovasc Interv 2018; 92:E288-E298. [DOI: 10.1002/ccd.27508] [Citation(s) in RCA: 11] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/30/2017] [Revised: 12/31/2017] [Accepted: 12/31/2017] [Indexed: 11/12/2022]
Affiliation(s)
- Hikaru Tsuruta
- Department of Cardiology; Keio University School of Medicine, Shinanomachi 35; Shinjuku-ku Tokyo 160-8582 Japan
| | - Kentaro Hayashida
- Department of Cardiology; Keio University School of Medicine, Shinanomachi 35; Shinjuku-ku Tokyo 160-8582 Japan
| | - Fumiaki Yashima
- Department of Cardiology; Keio University School of Medicine, Shinanomachi 35; Shinjuku-ku Tokyo 160-8582 Japan
| | - Ryo Yanagisawa
- Department of Cardiology; Keio University School of Medicine, Shinanomachi 35; Shinjuku-ku Tokyo 160-8582 Japan
| | - Makoto Tanaka
- Department of Cardiology; Keio University School of Medicine, Shinanomachi 35; Shinjuku-ku Tokyo 160-8582 Japan
| | - Takahide Arai
- Department of Cardiology; Keio University School of Medicine, Shinanomachi 35; Shinjuku-ku Tokyo 160-8582 Japan
| | - Yugo Minakata
- Department of Cardiology; Keio University School of Medicine, Shinanomachi 35; Shinjuku-ku Tokyo 160-8582 Japan
| | - Yuji Itabashi
- Department of Cardiology; Keio University School of Medicine, Shinanomachi 35; Shinjuku-ku Tokyo 160-8582 Japan
| | - Mitsushige Murata
- Department of Cardiology; Keio University School of Medicine, Shinanomachi 35; Shinjuku-ku Tokyo 160-8582 Japan
| | - Shun Kohsaka
- Department of Cardiology; Keio University School of Medicine, Shinanomachi 35; Shinjuku-ku Tokyo 160-8582 Japan
| | - Yuichiro Maekawa
- Department of Cardiology; Keio University School of Medicine, Shinanomachi 35; Shinjuku-ku Tokyo 160-8582 Japan
| | - Tatsuo Takahashi
- Department of Cardiovascular Surgery; Keio University School of Medicine, Shinanomachi 35; Shinjuku-ku Tokyo 160-8582 Japan
| | - Akihiro Yoshitake
- Department of Cardiovascular Surgery; Keio University School of Medicine, Shinanomachi 35; Shinjuku-ku Tokyo 160-8582 Japan
| | - Hideyuki Shimizu
- Department of Cardiovascular Surgery; Keio University School of Medicine, Shinanomachi 35; Shinjuku-ku Tokyo 160-8582 Japan
| | - Keiichi Fukuda
- Department of Cardiology; Keio University School of Medicine, Shinanomachi 35; Shinjuku-ku Tokyo 160-8582 Japan
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35
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den Uil CA, ter Horst M, Akin S, Galema TW. Severe Systolic Anterior Motion After Aortic Valve Replacement and Cox MAZE Surgery. J Card Surg 2016; 31:429-31. [DOI: 10.1111/jocs.12763] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/30/2022]
Affiliation(s)
| | | | - Sakir Akin
- ThoraxcenterErasmus Medical CenterRotterdamThe Netherlands
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36
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Left ventricular outflow tract obstruction masked by severe aortic stenosis. Gen Thorac Cardiovasc Surg 2015; 65:160-163. [DOI: 10.1007/s11748-015-0586-z] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/26/2015] [Accepted: 09/01/2015] [Indexed: 10/23/2022]
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37
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Wu JJ, Seco M, Medi C, Semsarian C, Richmond DR, Dearani JA, Schaff HV, Byrom MJ, Bannon PG. Surgery for hypertrophic cardiomyopathy. Biophys Rev 2015; 7:117-125. [PMID: 28509978 PMCID: PMC5418425 DOI: 10.1007/s12551-014-0153-3] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/22/2014] [Accepted: 11/25/2014] [Indexed: 01/17/2023] Open
Abstract
Hypertrophic cardiomyopathy (HCM) is a genetically determined cardiac disease characterised by otherwise unexplained myocardial hypertrophy of the left ventricle, and may result in left ventricular outflow tract obstruction. It is the most common cause of sudden cardiac death in young adults due to arrhythmias. Septal myectomy is a surgical treatment for HCM with moderate to severe outflow tract obstruction, and is indicated for patients with severe symptoms refractory to medical therapy. The surgical approach involves obtaining access to the interventricular septum via transaortic, transapical or transmitral approaches, and excising a portion of the hypertrophied myocardium to relieve the outflow tract obstruction. Large, contemporary series from centres experienced in septal myectomy patients have demonstrated a low early mortality of <2 %, excellent long-term survival that matches the general population, and durable relief of symptoms.
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Affiliation(s)
- James J Wu
- Sydney Medical School, The University of Sydney, Sydney, Australia
- The Baird Institute of Applied Heart & Lung Surgical Research, Sydney, Australia
- Cardiothoracic Surgery Unit, Royal Prince Alfred Hospital, Sydney, Australia
| | - Michael Seco
- Sydney Medical School, The University of Sydney, Sydney, Australia
- The Baird Institute of Applied Heart & Lung Surgical Research, Sydney, Australia
- Cardiothoracic Surgery Unit, Royal Prince Alfred Hospital, Sydney, Australia
| | - Caroline Medi
- Molecular Cardiology Group, Centenary Institute, Sydney, NSW, Australia
- Department of Cardiology, Royal Prince Alfred Hospital, Sydney, NSW, Australia
| | - Chris Semsarian
- Sydney Medical School, The University of Sydney, Sydney, Australia
- Molecular Cardiology Group, Centenary Institute, Sydney, NSW, Australia
- Department of Cardiology, Royal Prince Alfred Hospital, Sydney, NSW, Australia
| | - David R Richmond
- Department of Cardiology, Royal Prince Alfred Hospital, Sydney, NSW, Australia
| | | | | | - Michael J Byrom
- The Baird Institute of Applied Heart & Lung Surgical Research, Sydney, Australia
- Cardiothoracic Surgery Unit, Royal Prince Alfred Hospital, Sydney, Australia
| | - Paul G Bannon
- Sydney Medical School, The University of Sydney, Sydney, Australia.
- The Baird Institute of Applied Heart & Lung Surgical Research, Sydney, Australia.
- Cardiothoracic Surgery Unit, Royal Prince Alfred Hospital, Sydney, Australia.
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38
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Lim JY, Choi JO, Oh JK, Li Z, Park SJ. Concomitant Septal Myectomy in Patients Undergoing Aortic Valve Replacement for Severe Aortic Stenosis. Circ J 2015; 79:375-80. [DOI: 10.1253/circj.cj-14-0672] [Citation(s) in RCA: 10] [Impact Index Per Article: 1.1] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/09/2022]
Affiliation(s)
- Ju Yong Lim
- Division of Cardiovascular Surgery, Asan Medical Center
- Division of Cardiovascular Surgery, Mayo Clinic
| | - Jin Oh Choi
- Division of Cardiology, Samsung Medical Center
- Division of Cardiology, Mayo Clinic
| | - Jae Kon Oh
- Division of Cardiology, Samsung Medical Center
| | - Zhou Li
- Division of Biostatistics, Mayo Clinic
| | - Soon J. Park
- Division of Cardiovascular Surgery, Case Western Reserve University
- Division of Cardiovascular Surgery, Mayo Clinic
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39
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Varma PK, Puthuvassery Raman S, Unnikrishnan KP, Kundan S, Gadhinglajkar SV. Intraoperative transesophageal echocardiography diagnosis of concomitant hypertrophic cardiomyopathy with anomalous insertion of a papillary muscle band to the interventricular septum in a patient for aortic valve replacement. J Cardiothorac Vasc Anesth 2014; 28:e56-8. [PMID: 25440631 DOI: 10.1053/j.jvca.2014.06.023] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/02/2014] [Indexed: 11/11/2022]
Affiliation(s)
- Praveen Kerala Varma
- Division of Cardiac Surgery, Sree Chitra Tirunal Institute for Medical Sciences and Technology, Trivandrum, India
| | - Suneel Puthuvassery Raman
- Division of Anesthesiology, Sree Chitra Tirunal Institute for Medical Sciences and Technology, Trivandrum, India
| | | | - Simran Kundan
- Division of Cardiac Surgery, Sree Chitra Tirunal Institute for Medical Sciences and Technology, Trivandrum, India
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40
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Ryu IH, Kim WH, Ryu AJ, Kim MG, Jeon JW, Kim JS, Lee JJ, Choi JH. Percutaneous closure of an iatrogenic ventricular septal defect following concomitant septal myectomy at the time of aortic valve replacement. Korean Circ J 2014; 44:45-8. [PMID: 24497890 PMCID: PMC3905116 DOI: 10.4070/kcj.2014.44.1.45] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/28/2013] [Revised: 09/04/2013] [Accepted: 09/10/2013] [Indexed: 11/11/2022] Open
Abstract
A 77-year-old female patient underwent aortic valve replacement (AVR) with concomitant septal myectomy and tricuspid annuloplasty. Her symptoms did not improve after a successful operation. Echocardiogram demonstrated the presence of an iatrogenic ventricular septal defect (VSD). It was muscular in location and not the usual AVR with membraneous type of VSD, suggesting a complication from the myectomy. Percutaneous closure of the VSD remained the only feasible option due to her poor overall medical status. A 14-mm Amplazter VSD occluder was deployed successfully, by means of the trans-septal technique. She has improved very well postoperatively.
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Affiliation(s)
- Il Hwan Ryu
- Department of Internal Medicine, Eulji University Hospital, Eulji University School of Medicine, Daejeon, Korea
| | - Won Ho Kim
- Department of Internal Medicine, Eulji University Hospital, Eulji University School of Medicine, Daejeon, Korea
| | - Ah Jeong Ryu
- Department of Internal Medicine, Eulji University Hospital, Eulji University School of Medicine, Daejeon, Korea
| | - Min Gyu Kim
- Department of Internal Medicine, Eulji University Hospital, Eulji University School of Medicine, Daejeon, Korea
| | - Jae Woong Jeon
- Department of Internal Medicine, Eulji University Hospital, Eulji University School of Medicine, Daejeon, Korea
| | - Joo Seok Kim
- Department of Internal Medicine, Eulji University Hospital, Eulji University School of Medicine, Daejeon, Korea
| | - Jae Joon Lee
- Department of Internal Medicine, Eulji University Hospital, Eulji University School of Medicine, Daejeon, Korea
| | - Jin Ho Choi
- Division of Thoracic and Cardiovascular Surgery, Eulji University Hospital, Eulji University School of Medicine, Daejeon, Korea
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41
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Krishnaswamy A, Tuzcu EM, Svensson LG, Kapadia SR. Combined transcatheter aortic valve replacement and emergent alcohol septal ablation. Circulation 2014; 128:e366-8. [PMID: 24166418 DOI: 10.1161/circulationaha.112.000470] [Citation(s) in RCA: 18] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/16/2022]
Affiliation(s)
- Amar Krishnaswamy
- Departments of Cardiovascular Medicine (A.K., E.M.T., S.R.K.), and Cardiothoracic Surgery (L.G.S.), Cleveland Clinic, Cleveland, OH
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42
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Kasahara H, Inoue Y, Suzuki S, Hayashi I. Pseudo Systolic Anterior Motion: Potential for Severe Mitral Regurgitation after Aortic Valve Replacement. Ann Thorac Cardiovasc Surg 2014; 20:329-31. [DOI: 10.5761/atcs.cr.12.02053] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/16/2022] Open
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43
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Asymmetric septal hypertrophy in patients with severe aortic stenosis: The usefulness of associated septal myectomy. J Thorac Cardiovasc Surg 2013; 145:171-5. [DOI: 10.1016/j.jtcvs.2011.10.096] [Citation(s) in RCA: 29] [Impact Index Per Article: 2.6] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/19/2011] [Revised: 08/25/2011] [Accepted: 10/31/2011] [Indexed: 11/23/2022]
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44
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Ramamurthi A, Aker EM, Pandian NG. A Case of Aortic Stenosis and Hypertrophic Cardiomyopathy. Echocardiography 2012; 29:1261-3. [DOI: 10.1111/j.1540-8175.2012.01812.x] [Citation(s) in RCA: 7] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/29/2022] Open
Affiliation(s)
- Alamelu Ramamurthi
- Tufts Heart Valve Center; Tufts Medical Center; Tufts University School of Medicine; Boston; Massachusetts
| | - Eric M. Aker
- Tufts Heart Valve Center; Tufts Medical Center; Tufts University School of Medicine; Boston; Massachusetts
| | - Natesa G. Pandian
- Tufts Heart Valve Center; Tufts Medical Center; Tufts University School of Medicine; Boston; Massachusetts
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45
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Coutinho GF, Antunes MJ. Reply to Kestelli et al. Eur J Cardiothorac Surg 2012. [DOI: 10.1093/ejcts/ezr100] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/14/2022] Open
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46
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Krishnaswamy A, Tuzcu EM, Kapadia SR. Use of intraprocedural CT imaging to guide alcohol septal ablation of hypertrophic cardiomyopathy in the cardiac catheterization laboratory. Catheter Cardiovasc Interv 2012; 80:991-4. [DOI: 10.1002/ccd.23418] [Citation(s) in RCA: 8] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/16/2011] [Accepted: 10/07/2011] [Indexed: 11/09/2022]
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47
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Sorajja P, Booker JD, Rihal CS. Alcohol septal ablation after transaortic valve implantation: The dynamic nature of left outflow tract obstruction. Catheter Cardiovasc Interv 2012; 81:387-91. [DOI: 10.1002/ccd.23454] [Citation(s) in RCA: 17] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/20/2011] [Revised: 09/22/2011] [Accepted: 10/25/2011] [Indexed: 11/11/2022]
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48
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Schaff HV, Dearani JA, Ommen SR, Sorajja P, Nishimura RA. Expanding the indications for septal myectomy in patients with hypertrophic cardiomyopathy: Results of operation in patients with latent obstruction. J Thorac Cardiovasc Surg 2012; 143:303-9. [PMID: 22154797 DOI: 10.1016/j.jtcvs.2011.10.059] [Citation(s) in RCA: 63] [Impact Index Per Article: 5.3] [Reference Citation Analysis] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/03/2011] [Revised: 09/28/2011] [Accepted: 10/21/2011] [Indexed: 11/19/2022]
Affiliation(s)
- Hartzell V Schaff
- Divisions of Cardiovascular Surgery and Cardiovascular Diseases, Mayo Clinic, Rochester, MN 55905, USA.
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