Impact of Septal Myectomy on Left Atrial Volume and Left Ventricular Diastolic Filling Patterns

An Echocardiographic Study of Young Patients with Obstructive Hypertrophic Cardiomyopathy

Shaji C. Menon, Michael John Ackerman, Steve R. Ommen, Allison K. Cabalka, Donald J. Hagler, Patrick W. O'Leary, Joseph A. Dearani, Frank Cetta, Benjamin W. Eidem

Research output: Contribution to journalArticle

25 Citations (Scopus)

Abstract

Background: Septal myectomy in young patients with obstructive hypertrophic cardiomyopathy (HCM) can be performed with low mortality, and leads to excellent improvement in symptoms. Left atrial (LA) enlargement has been associated with exercise intolerance, severity of mitral regurgitation (MR), and left ventricular (LV) outflow tract (LVOT) obstruction in adults with HCM. Methods: Young patients (1-22 years of age) who had a septal myectomy for obstructive HCM between 2002 and 2005 were identified. Retrospective analyses of premyectomy and postmyectomy echocardiograms were performed. Results: In this cohort of 32 patients (25 male), the average maximal LV wall thickness was 25 ± 9 mm and LVOT maximal instantaneous gradient was 106 ± 44 mm Hg. MR was present in all patients with a mean grade of 3 ± 1. All patients had successful myectomy and there were no early deaths. After myectomy, LVOT maximal instantaneous gradient decreased to 17 ± 13 mm Hg (P < .0001). Mean LA volume (LAV) index decreased from 52.1 ± 2.2 to 33.2 ± 11.9 mL/m2 (P < .0001). Mean MR grade decreased to 2 ± 1. Early mitral medial annular tissue Doppler velocity (E') increased from 6.2 ± 1.9 to 13 ± 2.6 cm/s (P < .043). A postmyectomy decrease in LAV index correlated with decrease in LVOT obstruction (P = .001) and change in degree of MR (P = .04). Conclusion: Septal myectomy not only reduces LVOT maximal instantaneous gradient and MR in young patients, but also results in decreased LAV index, and E/A and E/E' ratios. These hemodynamic improvements may contribute to the observed survival benefit and increased exercise tolerance observed after myectomy. This is the first series to demonstrate that LAV correlates closely with hemodynamic status in children with obstructive HCM and may be a significant predictor of clinical outcome in these patients.

Original languageEnglish (US)
Pages (from-to)684-688
Number of pages5
JournalJournal of the American Society of Echocardiography
Volume21
Issue number6
DOIs
StatePublished - Jun 2008

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Hypertrophic Cardiomyopathy
Mitral Valve Insufficiency
Hemodynamics
Ventricular Outflow Obstruction
Exercise Tolerance
Exercise
Survival
Mortality

Keywords

  • Hypertrophic cardiomyopathy
  • Left atrial volume
  • Septal myectomy
  • Young

ASJC Scopus subject areas

  • Cardiology and Cardiovascular Medicine
  • Radiology Nuclear Medicine and imaging

Cite this

Impact of Septal Myectomy on Left Atrial Volume and Left Ventricular Diastolic Filling Patterns : An Echocardiographic Study of Young Patients with Obstructive Hypertrophic Cardiomyopathy. / Menon, Shaji C.; Ackerman, Michael John; Ommen, Steve R.; Cabalka, Allison K.; Hagler, Donald J.; O'Leary, Patrick W.; Dearani, Joseph A.; Cetta, Frank; Eidem, Benjamin W.

In: Journal of the American Society of Echocardiography, Vol. 21, No. 6, 06.2008, p. 684-688.

Research output: Contribution to journalArticle

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abstract = "Background: Septal myectomy in young patients with obstructive hypertrophic cardiomyopathy (HCM) can be performed with low mortality, and leads to excellent improvement in symptoms. Left atrial (LA) enlargement has been associated with exercise intolerance, severity of mitral regurgitation (MR), and left ventricular (LV) outflow tract (LVOT) obstruction in adults with HCM. Methods: Young patients (1-22 years of age) who had a septal myectomy for obstructive HCM between 2002 and 2005 were identified. Retrospective analyses of premyectomy and postmyectomy echocardiograms were performed. Results: In this cohort of 32 patients (25 male), the average maximal LV wall thickness was 25 ± 9 mm and LVOT maximal instantaneous gradient was 106 ± 44 mm Hg. MR was present in all patients with a mean grade of 3 ± 1. All patients had successful myectomy and there were no early deaths. After myectomy, LVOT maximal instantaneous gradient decreased to 17 ± 13 mm Hg (P < .0001). Mean LA volume (LAV) index decreased from 52.1 ± 2.2 to 33.2 ± 11.9 mL/m2 (P < .0001). Mean MR grade decreased to 2 ± 1. Early mitral medial annular tissue Doppler velocity (E') increased from 6.2 ± 1.9 to 13 ± 2.6 cm/s (P < .043). A postmyectomy decrease in LAV index correlated with decrease in LVOT obstruction (P = .001) and change in degree of MR (P = .04). Conclusion: Septal myectomy not only reduces LVOT maximal instantaneous gradient and MR in young patients, but also results in decreased LAV index, and E/A and E/E' ratios. These hemodynamic improvements may contribute to the observed survival benefit and increased exercise tolerance observed after myectomy. This is the first series to demonstrate that LAV correlates closely with hemodynamic status in children with obstructive HCM and may be a significant predictor of clinical outcome in these patients.",
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T2 - An Echocardiographic Study of Young Patients with Obstructive Hypertrophic Cardiomyopathy

AU - Menon, Shaji C.

AU - Ackerman, Michael John

AU - Ommen, Steve R.

AU - Cabalka, Allison K.

AU - Hagler, Donald J.

AU - O'Leary, Patrick W.

AU - Dearani, Joseph A.

AU - Cetta, Frank

AU - Eidem, Benjamin W.

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N2 - Background: Septal myectomy in young patients with obstructive hypertrophic cardiomyopathy (HCM) can be performed with low mortality, and leads to excellent improvement in symptoms. Left atrial (LA) enlargement has been associated with exercise intolerance, severity of mitral regurgitation (MR), and left ventricular (LV) outflow tract (LVOT) obstruction in adults with HCM. Methods: Young patients (1-22 years of age) who had a septal myectomy for obstructive HCM between 2002 and 2005 were identified. Retrospective analyses of premyectomy and postmyectomy echocardiograms were performed. Results: In this cohort of 32 patients (25 male), the average maximal LV wall thickness was 25 ± 9 mm and LVOT maximal instantaneous gradient was 106 ± 44 mm Hg. MR was present in all patients with a mean grade of 3 ± 1. All patients had successful myectomy and there were no early deaths. After myectomy, LVOT maximal instantaneous gradient decreased to 17 ± 13 mm Hg (P < .0001). Mean LA volume (LAV) index decreased from 52.1 ± 2.2 to 33.2 ± 11.9 mL/m2 (P < .0001). Mean MR grade decreased to 2 ± 1. Early mitral medial annular tissue Doppler velocity (E') increased from 6.2 ± 1.9 to 13 ± 2.6 cm/s (P < .043). A postmyectomy decrease in LAV index correlated with decrease in LVOT obstruction (P = .001) and change in degree of MR (P = .04). Conclusion: Septal myectomy not only reduces LVOT maximal instantaneous gradient and MR in young patients, but also results in decreased LAV index, and E/A and E/E' ratios. These hemodynamic improvements may contribute to the observed survival benefit and increased exercise tolerance observed after myectomy. This is the first series to demonstrate that LAV correlates closely with hemodynamic status in children with obstructive HCM and may be a significant predictor of clinical outcome in these patients.

AB - Background: Septal myectomy in young patients with obstructive hypertrophic cardiomyopathy (HCM) can be performed with low mortality, and leads to excellent improvement in symptoms. Left atrial (LA) enlargement has been associated with exercise intolerance, severity of mitral regurgitation (MR), and left ventricular (LV) outflow tract (LVOT) obstruction in adults with HCM. Methods: Young patients (1-22 years of age) who had a septal myectomy for obstructive HCM between 2002 and 2005 were identified. Retrospective analyses of premyectomy and postmyectomy echocardiograms were performed. Results: In this cohort of 32 patients (25 male), the average maximal LV wall thickness was 25 ± 9 mm and LVOT maximal instantaneous gradient was 106 ± 44 mm Hg. MR was present in all patients with a mean grade of 3 ± 1. All patients had successful myectomy and there were no early deaths. After myectomy, LVOT maximal instantaneous gradient decreased to 17 ± 13 mm Hg (P < .0001). Mean LA volume (LAV) index decreased from 52.1 ± 2.2 to 33.2 ± 11.9 mL/m2 (P < .0001). Mean MR grade decreased to 2 ± 1. Early mitral medial annular tissue Doppler velocity (E') increased from 6.2 ± 1.9 to 13 ± 2.6 cm/s (P < .043). A postmyectomy decrease in LAV index correlated with decrease in LVOT obstruction (P = .001) and change in degree of MR (P = .04). Conclusion: Septal myectomy not only reduces LVOT maximal instantaneous gradient and MR in young patients, but also results in decreased LAV index, and E/A and E/E' ratios. These hemodynamic improvements may contribute to the observed survival benefit and increased exercise tolerance observed after myectomy. This is the first series to demonstrate that LAV correlates closely with hemodynamic status in children with obstructive HCM and may be a significant predictor of clinical outcome in these patients.

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