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Crean AM, Gharibeh L, Saleem Z, Glineur D, Maharaj G, Grau JB. Extended Myectomy for Hypertrophic Cardiomyopathy: Early Outcomes from a Nascent Center of Excellence in Canada. CJC Open 2022; 4:921-928. [DOI: 10.1016/j.cjco.2022.06.012] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/28/2022] [Accepted: 06/21/2022] [Indexed: 11/25/2022] Open
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Bedair AH. This Time, It's Really Anesthesia's Fault. J Cardiothorac Vasc Anesth 2021; 36:338-339. [PMID: 34598865 DOI: 10.1053/j.jvca.2021.08.011] [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: 08/02/2021] [Accepted: 08/04/2021] [Indexed: 11/11/2022]
Affiliation(s)
- Ali H Bedair
- Division of Cardiothoracic and Vascular Anesthesiology, Baptist Memorial Hospital Memphis, TN; Department of Anesthesiology, College of Medicine, University of Tennessee Health Science Center Memphis, TN.
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Anwar AM, tenCate FJ. Echocardiographic evaluation of hypertrophic cardiomyopathy: A review of up-to-date knowledge and practical tips. Echocardiography 2021; 38:1795-1808. [PMID: 34555207 DOI: 10.1111/echo.15200] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/19/2021] [Revised: 07/24/2021] [Accepted: 08/23/2021] [Indexed: 11/27/2022] Open
Abstract
Hypertrophic cardiomyopathy (HCM) is the most frequent cardiac disease with genetic substrate, affecting about .2%-.5% of the population. The proper diagnosis is important for optimal management and follow-up. Echocardiography plays an essential role in the assessment of patients with HCM including diagnosis, screening, management formulation, prognosis, and follow up. It also helps to differentiate HCM from other diseases. The advancement of software and probe technology added many echo modalities and techniques that helped in refining the diagnostic and assessing the prognosis of patients with HCM. In this review, we briefly summarize how to integrate the different echocardiographic modalities to obtain comprehensive assessment supported by an updated knowledge of the latest guidelines and recently published articles. Many practical tips and tricks are included in this review to improve the diagnostic accuracy of echocardiography and minimize errors during interpretation.
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Affiliation(s)
- Ashraf M Anwar
- Department of Cardiology, King Fahad Armed Forces Hospital, Jeddah, Saudi Arabia.,Department of Cardiology, Faculty of Medicine, Al-Azhar University, Cairo, Egypt
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Wang X, Rastegar H, Rowin EJ, Robich M, Gonzalez-Ciccarelli LF, Cobey FC. Myocardial Bridge or Something Else? J Cardiothorac Vasc Anesth 2021; 36:332-337. [PMID: 34474950 DOI: 10.1053/j.jvca.2021.08.010] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/23/2021] [Accepted: 08/04/2021] [Indexed: 11/11/2022]
Abstract
In this E-Challenge, the authors report on a patient with symptoms of exertional dyspnea and angina, scheduled to have surgical unroofing of an identified myocardial bridge (MB). An MB is very common in patients with hypertrophic cardiomyopathy (HCM). Intraoperative transesophageal echocardiography with provocative maneuvers revealed the patient had a systolic anterior motion of the mitral valve with septal contact and resulting outflow tract obstruction despite the notable absence of significant basal septal hypertrophy. HCM has many phenotypic variants that can make the identification of patients with latent left ventricular outflow tract obstruction difficult in the absence of a high index of suspicion. In this report, the authors discuss the association between MBs and HCM and the importance of recognizing phenotypic variants of HCM.
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Affiliation(s)
- Xiaobin Wang
- Department of Anesthesiology and Perioperative Medicine, Tufts Medical Center, 800 Washington Street, Boston, MA 02111
| | - Hassan Rastegar
- Department of Cardiothoracic Surgery, Cardiovascular Center, Tufts Medical Center, 800 Washington Street, Boston, MA 02111
| | - Ethan J Rowin
- Department of Cardiology, Tufts Medical Center, 800 Washington Street, Boston, MA 02111
| | - Michael Robich
- Department of Cardiothoracic Surgery, Cardiovascular Center, Tufts Medical Center, 800 Washington Street, Boston, MA 02111
| | | | - Frederick C Cobey
- Department of Anesthesiology and Perioperative Medicine, Tufts Medical Center, 800 Washington Street, Boston, MA 02111.
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Addis DR, Townsley MM. Perioperative Implications of the 2020 American Heart Association/American College of Cardiology Guidelines for the Diagnosis and Treatment of Patients with Hypertrophic Cardiomyopathy: A Focused Review. J Cardiothorac Vasc Anesth 2021; 36:2143-2153. [PMID: 34373182 DOI: 10.1053/j.jvca.2021.07.024] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/06/2021] [Revised: 06/28/2021] [Accepted: 07/11/2021] [Indexed: 11/11/2022]
Abstract
Hypertrophic cardiomyopathy is a complex disease with significant implications for patients and the physicians called upon to care for them during the perioperative period. In this article, the 2020 American Heart Association and American College of Cardiology clinical practice guidelines for the evaluation and management of pediatric and adult patients with hypertrophic cardiomyopathy are reviewed, with a particular focus on perioperative considerations for the anesthesiologist.
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Affiliation(s)
- Dylan R Addis
- Division of Cardiothoracic Anesthesiology, Department of Anesthesiology and Perioperative Medicine, The University of Alabama at Birmingham School of Medicine, Birmingham, AL; Division of Molecular and Translational Biomedicine, Department of Anesthesiology and Perioperative Medicine, The University of Alabama at Birmingham School of Medicine, Birmingham, AL; UAB Comprehensive Cardiovascular Center, Birmingham, AL
| | - Matthew M Townsley
- Division of Cardiothoracic Anesthesiology, Department of Anesthesiology and Perioperative Medicine, The University of Alabama at Birmingham School of Medicine, Birmingham, AL; Division of Congenital Cardiac Anesthesiology, Department of Anesthesiology and Perioperative Medicine, The University of Alabama at Birmingham School of Medicine, Birmingham, AL; Bruno Pediatric Heart Center, Children's of Alabama, Birmingham, AL.
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Carvalho JL, Ashikhmina E, Abel MD, Viehman JK, Lahr BD, Geske JB, Schaff HV. Hypertrophic Obstructive Cardiomyopathy: Discrepancy Between Hemodynamic Measurements in the Cardiac Laboratory and Operating Room Is to Be Expected. J Cardiothorac Vasc Anesth 2021; 36:422-428. [PMID: 34172363 DOI: 10.1053/j.jvca.2021.05.041] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/19/2021] [Revised: 05/15/2021] [Accepted: 05/17/2021] [Indexed: 11/11/2022]
Abstract
OBJECTIVES It is not uncommon to observe some discrepancy in hemodynamic values characterizing left ventricular outflow tract (LVOT) obstruction preoperatively and in the operating room in patients with hypertrophic obstructive cardiomyopathy. Interpretation of this discrepancy can be challenging. To clarify the extent of the discrepancy, the authors compared hemodynamic variables in patients undergoing septal myectomy at the time of preoperative and intraoperative evaluation. DESIGN Retrospective study. SETTING Single academic medical center. INTERVENTIONS Medical records review, study group-173 patients. MEASUREMENTS AND MAIN RESULTS While there was no statistically significant difference in resting peak LVOT gradients by preoperative transthoracic echocardiography (TTE) compared to intraoperative transesophageal echocardiography (46 mmHg [19-87 mmHg] v 36 mmHg [16-71 mmHg], p = 0.231), the former were higher compared to direct needle-resting LVOT gradient measurements before myectomy (49 mmHg [19-88 mmHg] v 32 mmHg [14-67 mmHg], p = 0.0022). The prevalence of systolic anterior motion was high (94.6% v 91.6%, P = 1.000) both on pre- and intraoperative evaluation. The incidence of moderate/severe mitral was higher intraoperatively (p < 0.0001). Pulmonary artery systolic pressures measured by pulmonary artery catheter provided higher values compared to preoperative TTE estimate (39 mmHg [34-45 mmHg] v 34 mmHg [28-41 mmHg], p < 0.0001). CONCLUSIONS Discrepancy between hemodynamic measurements in the cardiac laboratory and operating room is common and generally should not affect planned patients' care. These changes in hemodynamics might be explained by preoperative fasting, anesthetic agents, volume shifts while supine, and positive-pressure ventilation, as well as the difference in measurement techniques.
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Affiliation(s)
| | - Elena Ashikhmina
- Department of Anesthesiology and Perioperative Medicine, Mayo Clinic, Rochester, MN.
| | - Martin D Abel
- Department of Anesthesiology and Perioperative Medicine, Mayo Clinic, Jacksonville, FL
| | - Jason K Viehman
- Department of Quantitative Health Sciences, Mayo Clinic, Rochester, MN
| | - Brian D Lahr
- Department of Quantitative Health Sciences, Mayo Clinic, Rochester, MN
| | - Jeffrey B Geske
- Department of Cardiovascular Medicine, Mayo Clinic, Rochester, MN
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La Canna G, Scarfò I, Arendar I, Colombo A, Torracca L, Margonato D, Montorfano M, Alfieri O. Targeting Alcohol Septal Ablation in Patients with Obstructive Hypertrophic Cardiomyopathy Candidates for Surgical Myectomy: Added Value of Three-Dimensional Intracoronary Myocardial Contrast Echocardiography. J Clin Med 2021; 10:jcm10102166. [PMID: 34067830 PMCID: PMC8156226 DOI: 10.3390/jcm10102166] [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] [Subscribe] [Scholar Register] [Received: 03/23/2021] [Revised: 05/11/2021] [Accepted: 05/14/2021] [Indexed: 01/06/2023] Open
Abstract
Background: Myocardial contrast two-dimensional echocardiography (MC-2DE) is widely used to address alcohol septal ablation (ASA) in obstructive hypertrophic cardiomyopathy (HCM). Owing to its limited cut-planes, MC-2DE may inaccurately identify the contrast misplacement associated with an unsuccessful or complicated ASA outcome. Objective: The aim of this study was to assess the added value of myocardial contrast three-dimensional echocardiography (MC-3DE) compared with MC-2DE to identify the appropriate matching between the target septal zone (TSZ) and coronary artery branch for safe and long-term effective ASA in HCM patients. Methods: A consecutive series of 52 symptomatic obstructive HCM patients referred for isolated surgical myectomy (SM) was analyzed with MC-2DE and MC-3DE following injection of echocontrast into one or more septal branches. MC-2DE and MC-3DE patterns were categorized according to complete (Type 1) or incomplete (Type 2) TSZ covering, high-risk (Type 3) exceeding TSZ, or life-threatening outside TSZ distribution (Type 4). Results: MC-2DE per patient analysis showed a Type 1 pattern in 32 patients and Types 2–4 in the remaining 20 patients; subsequent MC-3DE analysis provided a re-phenotyping of MC-2DE findings in 22 of the 52 patients (42%), showing a high-risk Type 2 pattern in 17 of the 32 patients with Type 1, and a new life-threatening Type 4 in three patients with Type 2, respectively. All patients with MC-3DE Type 1 pattern underwent safe and effective ASA with a long-term uneventful follow-up, while the remaining patients underwent SM. Conclusions: Refining high risk or life-threatening contrast misplacement, MC-3DE is more accurate than conventional MC-2DE to target safe and long-term effective septal reduction with ASA in obstructive HCM patients referred for isolated SM.
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Affiliation(s)
- Giovanni La Canna
- Applied Diagnostic Echocardiography Unit, IRCCS Humanitas Clinical and Research Center, 20089 Rozzano, Italy; (I.S.); (I.A.)
- Correspondence: ; Tel.: +39-33-5674-4319
| | - Iside Scarfò
- Applied Diagnostic Echocardiography Unit, IRCCS Humanitas Clinical and Research Center, 20089 Rozzano, Italy; (I.S.); (I.A.)
| | - Irina Arendar
- Applied Diagnostic Echocardiography Unit, IRCCS Humanitas Clinical and Research Center, 20089 Rozzano, Italy; (I.S.); (I.A.)
| | - Antonio Colombo
- Interventional Cardiology Unit, IRCCS Humanitas Clinical and Research Center, 20089 Rozzano, Italy;
| | - Lucia Torracca
- Cardiac Surgery, IRCCS Humanitas Clinical and Research Center, 20089 Rozzano, Italy;
| | - Davide Margonato
- Interventional Cardiology Unit, IRCCS San Raffaele Scientific Institute, 20132 Milan, Italy; (D.M.); (M.M.)
| | - Matteo Montorfano
- Interventional Cardiology Unit, IRCCS San Raffaele Scientific Institute, 20132 Milan, Italy; (D.M.); (M.M.)
| | - Ottavio Alfieri
- Cardiac Surgery Unit, IRCCS San Raffaele Scientific Institute, 20132 Milan, Italy;
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Pulido J, Lehr EJ. Commentary: Exposing the Beast: The Importance of Provocative Maneuvers During Septal Myectomy. Semin Thorac Cardiovasc Surg 2021; 33:1043-1044. [PMID: 33609682 DOI: 10.1053/j.semtcvs.2021.01.038] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/20/2020] [Accepted: 01/05/2021] [Indexed: 11/11/2022]
Affiliation(s)
- Juan Pulido
- Critical Care Medicine and Cardiovascular Anesthesiology, Medical Director CVICU, Swedish Medical Center, US Anesthesia Partners, Cherry Hill Campus, Seattle, WA 98122.
| | - Eric J Lehr
- Department is Cardiac Surgery, Swedish Medical Center, Cherry Hill Campus, Seattle, WA 98122
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Timek TA. Commentary: Now you see me, now you don't-the peek-and-boo left ventricular outflow obstruction gradient. J Thorac Cardiovasc Surg 2021; 164:1870-1871. [PMID: 33551071 DOI: 10.1016/j.jtcvs.2020.12.128] [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: 12/27/2020] [Revised: 12/27/2020] [Accepted: 12/28/2020] [Indexed: 10/22/2022]
Affiliation(s)
- Tomasz A Timek
- Division of Cardiothoracic Surgery, Spectrum Health, Grand Rapids, Mich.
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