ATS
HOME HELP FEEDBACK SUBSCRIPTIONS ARCHIVE SEARCH TABLE OF CONTENTS
QUICK SEARCH:   [advanced]


     

Ann Thorac Surg 2008;85:1527-1535. doi:10.1016/j.athoracsur.2008.01.061
© 2008 The Society of Thoracic Surgeons
This Article
Right arrow Full Text
Right arrow Full Text (PDF)
Right arrow Alert me when this article is cited
Right arrow Alert me if a correction is posted
Right arrow Citation Map
Services
Right arrow Email this article to a friend
Right arrow Similar articles in this journal
Right arrow Alert me to new issues of the journal
Right arrow Add to Personal Folders
Right arrow Download to citation manager
Right arrow Author home page(s):
Bruce W. Lytle
Eugene H. Blackstone
Nicholas G. Smedira
Right arrow Permission Requests
Google Scholar
Right arrow Articles by Kaple, R. K.
Right arrow Articles by Smedira, N. G.
PubMed
Right arrow Articles by Kaple, R. K.
Right arrow Articles by Smedira, N. G.
Related Collections
Right arrow Valve disease
Right arrowRelated Article

Original Articles: Adult Cardiac

Mitral Valve Abnormalities in Hypertrophic Cardiomyopathy: Echocardiographic Features and Surgical Outcomes

Ryan K. Kaple, BSa, Ross T. Murphy, MDb, Linda M. DiPaola, BAc, Penny L. Houghtaling, MSc, Harry M. Lever, MDb, Bruce W. Lytle, MDa, Eugene H. Blackstone, MDa,c, Nicholas G. Smedira, MDa,*

a Department of Thoracic and Cardiovascular Surgery, The Cleveland Clinic, Cleveland, Ohio
b Department of Cardiovascular Medicine, The Cleveland Clinic, Cleveland, Ohio
c Department of Quantitative Health Sciences, The Cleveland Clinic, Cleveland, Ohio

Accepted for publication January 15, 2008.

* Address correspondence to Dr Smedira, Kaufman Center for Heart Failure, Department of Thoracic and Cardiovascular Surgery, The Cleveland Clinic, 9500 Euclid Ave/F24, Cleveland, OH 44195 (Email: smedirn{at}ccf.org).

Background: Functional and intrinsic mitral valve (MV) abnormalities are common in hypertrophic cardiomyopathy (HCM); however, morphologic characteristics constituting indications for surgical intervention are incompletely defined. This study was conducted to define the echocardiographic features of MV pathology in patients with HCM and relate these to repairability of the MV, MV procedures performed, durability of repair, and survival.

Methods: From 1986 to 2003, 851 patients with HCM underwent operation, and 115 had a concomitant MV procedure. Detailed analysis of their 784 transthoracic and transesophageal echocardiograms, performed intraoperatively and postoperatively, was conducted. Outcomes were assessed by cross-sectional follow-up.

Results: Sixty-seven patients (58%) underwent MV repair, and 48 (42%) had MV replacement. The mean left ventricular outflow tract peak gradient was 70 ± 50 mm Hg. Systolic anterior motion was present in 95%. Valve abnormalities were degenerative in 36 (31%), myxomatous in 23 (20%), papillary muscle in 23 (20%), restrictive chordal in 22 (19%), restrictive leaflet in 80 (70%), and long leaflet in 64 (56%). Patients undergoing MV repair had higher prevalence of long leaflets and degenerative MV pathology. The anterior mitral leaflet was 3.0 ± 0.49 cm in the repair group vs 2.5 ± 0.40 cm in the replacement group (p = 0.0001). MV replacement patients were older, more symptomatic, and had more renal dysfunction and lower hematocrits. By 3 years, 91% of patients with a repair were free of reoperation.

Conclusions: Intrinsic MV pathology is frequently observed in HCM patients with symptomatic obstruction who undergo myectomy. Echocardiography can identify MV features predictive of successful valve repair. Repair, although durable, is feasible in only about half of patients.


Related Article

Invited Commentary
Robert A.E. Dion
Ann. Thorac. Surg. 2008 85: 1536. [Extract] [Full Text] [PDF]





HOME HELP FEEDBACK SUBSCRIPTIONS ARCHIVE SEARCH TABLE OF CONTENTS
ANN THORAC SURG ASIAN CARDIOVASC THORAC ANN EUR J CARDIOTHORAC SURG
J THORAC CARDIOVASC SURG ICVTS ALL CTSNet JOURNALS
Copyright © 2008 by The Society of Thoracic Surgeons.