An Echocardiographic Study Of Abnormal Mitral Valve Apparatus In Hypertrophic Obstructive Cardiomyopathy

1 The Value of Echocardiography to Evaluate Intrinsic Mitral Valve Disease in Patients With Hypertrophic Obstructive Cardiomyopathy[Objectives]To analyze the value of echocardiography to evaluate intrinsic MV disease in patients with HOCM,and summarize diagnostic experience.[Methods]A total of 480 extended septal myectomy performed in adults from 2010 to 2017 at Fuwai hospital by individual experienced surgeon.Pre-operative echocardiography of 22 patients who underwent concomitant mitral valve procedures were reviewed retrospectively.Then analyzed the reason of misdiagnosis and summarized diagnostic experience.[Results]For 480 patients with HOCM,post-operative IVS,LAD,MI,LVOT-PG and LVEF all decreased significantly,LVEDD increased significantly(P<0.01).Mitral regurgitation are related to SAM in 458 cases(95.4%),and all released after adequate myectomy.22 patients(4.6%)had concomitant mitral valve abnormality,and consisted of 12 cases with Prolapse(54.5%),4 cases with degeneration(18.2%),4 cases with endocarditis(18.2%),2 cases with rheumatism(9.1%).In 7 patients with posterior leaflet prolapse,6 cases combined with rupture of chordae tendineae.For the mitral valve abnormality in 22 cases,12 cases were identified by pre-operative TTE;2 cases were identified by pre-operative TEE complementally,4 cases were identified by first surgical exploration,the other 4 cases were identified by second surgical exploration.And only 16.7%cases with rupture of chordae tendineae were identified by pre-operative TTE.[Conclusions]Most mitral regurgitation in patients with HOCM are SAM related,and almost can be relieved by adequate septal myectomy.Only a few patients with HOCM are combined with intrinsic mitral valve disease,and need surgical intervention in the meanwhile.Echocardiography is very important to estimate the reason of mitral regurgitation,and identify intrinsic mitral valve diseases of HOCM pre-operatively.2 Prolonged leaflets and abnormal tenting morphologhy of mitral valve in patients with hypertrophic obstructive cardiomyopathy[Objective]To evaluate the severity of mitral regurgitation,and the leaflet length and tenting morphologhy of mitral valve,before and after extended septal myectomy in patients with HOCM by echocardiography.[Methods]52 patients with HOCM were involved in this research,who underwent extended septal myectomy from 2012 to 2017 at Fuwai hospital by individual experienced surgeon.The parameters of mitral valve were compared between HCOM and normal controls,and between pre-operative and post-operative HOCM by echocardiography retrospectively.[Results]Compared with the controls,52 HOCM patients all had enlarged LAD,thickened IVS,and decreased LVEDD(P<0.01).Ann D,ALL,PLL,APM,PPM all increased significantly(P<0.01).Pro L and Pro R both decreased significantly(P<0.01).Ten H has no statistical difference compared with controls(P>0.01).C-sept and S-P both decreased significantly(P<0.01).After septal myectomy,LVOT-PG and MI both decreased significantly(P<0.01).Ann D,Pro L,Pro R,Ten H all have no statistical difference compared with pre-operative measurements(P>0.01).C-sept and S-P both increased significantly(P<0.01).LAD,IVS,LVPWD,LVEF all decreased significantly(P<0.01).LVEDD increased significantly(P<0.01).[Conclusions]The mitral valve of HOCM has a series of typical change,which includes prolonged leaflets,anterior displacement of papillary muscle and abnormal chordae or muscle bandle.Mitral regurgitation related to SAM in patients with HOCM can be relieved through adequate myectomy.Although most patients have prolonged leaflets of mitral valve,there is no recurrent,or aggravated significant mitral regurgitation during midterm follow-up post-operatively.HOCM patients have abnormal tenting morphologhy of mitral valve,after septal myectomy,the abnormal tenting morphologhy had been persistent.