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Ann Thorac Surg 1997;64:739-745
© 1997 The Society of Thoracic Surgeons

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Original Article: General Thoracic

Septal Myectomy in Hypertrophic Obstructive Cardiomyopathy: Late Results With Stress Echocardiography

M. Kamil Göl, MD, Mustafa Emir, MD, Talat Kele, MD, eref A. Küçüker, MD, C. Levent Birinciolu, MD, Y. Haldun Karagöz, MD, Tevfik Kural, MD, Ouz Tademir, MD, Siber Göksel, MD, Kemal Bayazit, MD

Cardiovascular Surgery Clinic and Cardiology Clinic, Türkiye Yüksek htisas Hospital, Ankara, Turkey

Accepted for publication March 22, 1997.

Background. This study was performed to assess the functional capacity of the survivors of septal myectomy for the treatment of hypertrophic obstructive cardiomyopathy in long-term follow-up as assessed by dobutamine stress echocardiography.

Methods. Sixty-nine patients with hypertrophic obstructive cardiomyopathy underwent septal myectomy between 1975 and 1996. The mean age was 25.4 ± 13.6 years (range, 6–58 years), and 10 of the patients were women. The early mortality was 4.3%. Hospital survivors (95.7%) were followed up for a mean of 43.8 ± 28.7 months (range, 6–114 months).

Results. The postoperative mean functional capacity of the group was 1.47 ± 0.56. No late deaths were reported. Forty-nine patients (74.2%) were evaluated with standard echocardiographic techniques, and 29 (43.9%) patients underwent dobutamine stress echocardiography. There was a significant decrease in the thickness of the interventricular septum after surgery. The mean preoperative and postoperative septal thickness was 1.99 ± 0.59 cm (range, 1.3–3.8 cm) and 1.55 ± 0.41 cm (range, 0.96–2.8 cm), respectively (p < 0.004). The mean posterior wall thickness was significantly less than the preoperative value (p = 0.008) and the left ventricular end-diastolic diameter was slightly greater in the postoperative measurements, but the difference was not significant (p = 0.162). Postoperative left ventricular outflow systolic gradients were reduced significantly when compared with preoperative values (preoperative mean, 78.4 ± 33.6 mm Hg, range, 50–212 mm Hg versus postoperative mean, 17.9 ± 15.9 mm Hg; range, 0–40 mm Hg; p < 0.0001).

Conclusion. Septal myectomy for patients with hypertrophic obstructive cardiomyopathy is a safe procedure with excellent clinical and functional results in the long-term follow-up.

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