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The Annals of Thoracic Surgery, Vol 48, 528-534, Copyright © 1989 by The Society of Thoracic Surgeons
WS Walker, KG Reid, EW Cameron, PR Walbaum and AH Kitchin
We have reviewed the results of two different forms of surgical management
of hypertrophic obstructive cardiomyopathy refractory to medical therapy.
Twenty-one patients were treated with 22 procedures between 1963 and 1987.
Eleven underwent a ventricular septal procedure by myotomy with or without
myectomy, and 11 underwent mitral valve replacement (MVR), 1 of whom had
previously undergone a ventricular septal procedure. The groups were
comparable with respect to severity and duration of symptoms, age range,
electrocardiographic features, and hemodynamic changes. Mitral valve
replacement produced a greater and more consistent reduction in the left
ventricular outflow tract pressure gradient than a ventricular septal
procedure (MVR, 68.3 mm Hg preoperatively and 2.5 mm Hg postoperatively;
ventricular septal procedure, 60.1 mm Hg preoperatively and 13.4 mm Hg
postoperatively). This was associated with better postoperative ventricular
configuration in diastole and more apparent loss of midcavity narrowing in
systole. Ejection fraction did not fall after a ventricular septal
procedure but decreased significantly from a mean of 79% to a mean of 61%
after MVR. Similarly, left ventricular end-diastolic pressure remained
unchanged after a ventricular septal procedure but fell from a mean of 26.6
mm Hg to 17 mm Hg after MVR. Although both groups experienced a generally
satisfactory symptomatic result, this appeared more reliable with MVR. We
suggest that MVR offers a more predictable improvement than a ventricular
septal procedure and may be the procedure of choice for units with limited
experience with ventricular septal procedures.
ARTICLES
Comparison of ventricular septal surgery and mitral valve replacement for hypertrophic obstructive cardiomyopathy
Department of Cardiology, Western General Infirmary, Edinburgh, Scotland.
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