Impact of secondary mitral valve chordal cutting on valve geometry in obstructive hypertrophic cardiomyopathy with marked septal hypertrophy.

Autor:	Zyrianov A; Centro per la Cardiomiopatia Ipertrofica, Policlinico di Monza, Monza 20900, Italy.; Cardiochirurgia, Università degli Studi di Milano, Milan 20900, Italy., Spirito P; Centro per la Cardiomiopatia Ipertrofica, Policlinico di Monza, Monza 20900, Italy., Abete R; Centro per la Cardiomiopatia Ipertrofica, Policlinico di Monza, Monza 20900, Italy., Margonato D; Centro per la Cardiomiopatia Ipertrofica, Policlinico di Monza, Monza 20900, Italy., Poggio D; Centro per la Cardiomiopatia Ipertrofica, Policlinico di Monza, Monza 20900, Italy., Vaccari G; Centro per la Cardiomiopatia Ipertrofica, Policlinico di Monza, Monza 20900, Italy., Binaco I; Centro per la Cardiomiopatia Ipertrofica, Policlinico di Monza, Monza 20900, Italy.; UOC Cardiochirurgia Fondazione IRCCS Ca' Granda Ospedale Maggiore Policlinico, Milan 20900, Italy., Grillo M; Centro per la Cardiomiopatia Ipertrofica, Policlinico di Monza, Monza 20900, Italy., Dorobantu L; Cardiomyopathy Center, Spitalul Monza, Bucharest 20900, Romania., Boni L; Epidemiologia Clinica, IRCSS Ospedale Policlinico San Martino, Genoa 20900, Italy., Ferrazzi P; Centro per la Cardiomiopatia Ipertrofica, Policlinico di Monza, Monza 20900, Italy.
Jazyk:	angličtina
Zdroj:	European heart journal. Cardiovascular Imaging [Eur Heart J Cardiovasc Imaging] 2023 Apr 24; Vol. 24 (5), pp. 678-686.
DOI:	10.1093/ehjci/jeac179
Abstrakt:	Aims: In patients with obstructive hypertrophic cardiomyopathy (HCM) and mild septal thickness undergoing myectomy, resecting fibrotic anterior mitral leaflet (AML) secondary chordae moves the mitral valve (MV) away from the outflow tract and ejection flow, reducing the need for a deep septal excision. Aim of the present study was to assess whether chordal resection has similarly favourable effects in patients with important hypertrophy, who represent the majority of patients with obstructive HCM. Methods and Results: The MV position in the ventricular cavity, assessed from echocardiography as AML-annulus ratio, was compared before and after chordal resection in 150 consecutive HCM patients with important (≥20 mm) and 62 with mild (≤19 mm) septal thickness undergoing myectomy. Preoperatively, MV position was displaced towards the septum to a similar extent in both groups. Postoperatively, AML-annulus ratio increased of an equal degree in both groups, from 0.43 ± 0.05 to 0.55 ± 0.06 (P < 0.001) a 28% increase, and from 0.43 ± 0.06 to 0.55 ± 0.06 (P < 0.001) a 26% increase, respectively, indicating a similar MV shift away from the outflow tract. When AML-annulus ratio was compared in the study cohort and 124 normal subjects, MV position was within normal range in <4% of patients preoperatively and normalized in >50% postoperatively. Conclusions: In obstructive HCM, displacement of the MV apparatus into the outflow tract interferes with the ejection flow. Resection of fibrotic secondary chordae moves the MV apparatus away from the outflow tract and enlarges the outflow area independently of septal thickness, facilitating septal myectomy by reducing the need for a deep muscular excision. Competing Interests: Conflict of interest: None declared. (© The Author(s) 2022. Published by Oxford University Press on behalf of the European Society of Cardiology. All rights reserved. For permissions, please email: journals.permissions@oup.com.)
Databáze:	MEDLINE
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