Operation Treatment Of Hypertrophic Obstructive Cardiomyopathy

Hypertrophic obstructive cardiomyopathy (HOCM) is an autosomal dominant genetic disease. Hypertrophic obstructive cardiomyopathy is the more common type of primary Cardiomyopathy. Hypertrophic obstructive cardiomyopathy is a special type of hypertrophic cardiomyopathy.The disease often have significant family history (about 30%) which often causes sudden death for young people.Davies reported that five of nine brothers and sisters of one family had the disease in 1952,three of them arise sudden death.Obstruction usually occurs in the infer-aortic valve or the central of ventricle under, obstructive symptoms can be hidden, intermittent or persistent, the merger abnormal systolic anterior mitral valve prior to the movement that is:SAM phenomenon.The lesion is characterized by hemodynamic abnormalities, mainly for left ventricular volume reduced, resulting in left ventricular interval and the distance between the anterior mitral leaflet significantly shortened the contraction of careful room prior to the anterior mitral leaflet movement (SAM), thereby increasing the left ventricular outflow tract (LVOT) obstruction degree. The main clinical of Hypertrophic obstructive cardiomyopathy is manifestations of exertional palpitations, shortness of breath, chest pain, and even syncope. Frequently the patients suffer from the conduct of advanced congestive heart failure, often due to severe outflow tract obstruction and concurrent atrial fibrillation caused. The 80% of Hypertrophic obstructive cardiomyopathy patients have exertional dyspnea, about 2/3 of patients have atypical angina, about 1/3 of patients have threatened syncope or syncope, often after the event occurred. The time of operation treatment of Hypertrophic Obstructive Cardiomyopathy has had near 40 years,but the initial effect was not satisfied. In recent years, along with the physiopathology of Hypertrophic Obstructive Cardiomyopathy further understanding, The concepts and methods of surgical correction also will be changed a lotObjective The most effective treatment of symptomatic patients with hypertrophic obstructive cardiomyopathy is still disputed. Treatment options include medical therapy, pacemaker insertion, percutaneous transluminal septal myocardial ablation, mitral valve replacement, and surgical resection of obstructing muscle. To investigate the effective,means and indication of Operation Treatment of Hypertrophic Obstructive Cardiomyopathy.Methods Ten patients with Hypertrophic Obstructive Cardiomyopathy were operated upon at the First Affiliated hospital of Zhengzhou University between Oct.2000 and Dec.2008.Myotomy and myectomy of interventricular septum by an aortic approach were performed ten patients and simultaneous mitral valve replacement through atrial incis in one of ten patients.Results Ten cases were successful and no one died. Left ventricular outfiow tract pressure gradient(LVOTPG) was reduced over 60%after operating. The resting LVOTPG was reduced from (68.40±16.12) mmHg to (16.65±12.75)mmHg (p<0.01).The Provoked LVOTPG was reduced from(110.44±34.21) mmHg to (31.85±22.64)mmHg (p<0.01)。The thickness of heart ventricle septal decreased from (23.44±2.51)mm to (11.35±1.73)mm (p<0.05)。The inner diameter of LVOT was increased from (10.93±3.31)mm to (19.17±3.64) mm (p<0.05)。The clinical symptoms such as syncope, dizziness, angina, dyspnea and so on disappeared in all patients. The noise of the left border of breast bone disappeared or reduced,the chatter disappeared.The noise of apical region disappeared. The heart function of all patients recovered to theⅠ-Ⅱclass. One patient required permanent pacemaker because of the complete atrioventricular block. The thickness of heart ventricle septal thinningzed, the mitral regurgitation obviously decreased or disappeared and the phenomenon of SAM disappeared by ECHO.The time of follow-up visiting was from three months to eight years, no one died.All patients can normal work.Conclusion Left ventricular outflow tract obstruction can be effectively relieved by Operation Treatment. The gradient pressure apparently came down.It can improve the symptom of many patiens with hypertrophic obstructive cardiomyopathy in long term. At present we think that surgical part resection of obstructing muscle is the first choice which treats the symptomatic patients with hypertrophic obstructive cardiomyopathy.