Intraoperative direct measurement of left ventricular outflow tract gradients to guide surgical myectomy for hypertrophic cardiomyopathy

Elena A. Ashikhmina, Hartzell V Schaff, Steve R. Ommen, Joseph A. Dearani, Rick A. Nishimura, Martin D. Abel

Research output: Contribution to journalArticle

31 Citations (Scopus)

Abstract

Objectives: We sought to summarize our recent experience with intraoperative monitoring for management of patients undergoing surgical myectomy for hypertrophic obstructive cardiomyopathy with emphasis on dynamic left ventricular outflow tract obstruction. We also analyzed the impact of these data on surgical decision-making and adequacy of septal myectomy. Methods: We retrospectively analyzed the medical records of 198 patients who underwent transaortic septal myectomy and evaluated baseline and provoked left ventricular outflow tract gradients obtained by Doppler echocardiography and by direct measurement of pressures in the left ventricle and aorta. Results: After induction of anesthesia before myectomy, left ventricular outflow tract obstruction, assessed by direct measurement, was less than the gradient documented by preoperative Doppler echocardiography in 119 patients (60%) (41 ± 31 vs 76 ± 40 mm Hg; P < .001). In 75 patients (38%), the obstruction was more severe (64 ± 32 vs 35 ± 31 mm Hg; P < .001); 4 patients (2%) had similar left ventricular outflow tract gradients. After myectomy, left ventricular outflow tract gradient decreased markedly (49 ± 33 vs 4 ± 8 mm Hg [P < .001] by direct measurement; 59 ± 42 vs 4 ± 6 mm Hg [P < .001] by transesophageal echocardiography). Cardiopulmonary bypass was resumed for more extensive myectomy in 8 (4%) patients because of a persistent residual left ventricular outflow tract gradient of 33 ± 14 mm Hg. Of note, for 78 patients (39%) intraoperative Doppler echocardiographic assessment of left ventricular outflow tract gradient was technically inadequate. Conclusions: Direct intraoperative measurement of pressures in the left ventricle and aorta provides important hemodynamic data in addition to intraoperative transesophageal echocardiography findings. This information assists the surgeon in defining the extent of myectomy.

Original languageEnglish (US)
Pages (from-to)53-59
Number of pages7
JournalJournal of Thoracic and Cardiovascular Surgery
Volume142
Issue number1
DOIs
StatePublished - Jul 2011

Fingerprint

Hypertrophic Cardiomyopathy
Ventricular Outflow Obstruction
Doppler Echocardiography
Transesophageal Echocardiography
Heart Ventricles
Aorta
Intraoperative Monitoring
Pressure
Cardiopulmonary Bypass
Medical Records
Decision Making
Anesthesia
Hemodynamics

ASJC Scopus subject areas

  • Cardiology and Cardiovascular Medicine
  • Surgery
  • Pulmonary and Respiratory Medicine

Cite this

Intraoperative direct measurement of left ventricular outflow tract gradients to guide surgical myectomy for hypertrophic cardiomyopathy. / Ashikhmina, Elena A.; Schaff, Hartzell V; Ommen, Steve R.; Dearani, Joseph A.; Nishimura, Rick A.; Abel, Martin D.

In: Journal of Thoracic and Cardiovascular Surgery, Vol. 142, No. 1, 07.2011, p. 53-59.

Research output: Contribution to journalArticle

Ashikhmina, Elena A. ; Schaff, Hartzell V ; Ommen, Steve R. ; Dearani, Joseph A. ; Nishimura, Rick A. ; Abel, Martin D. / Intraoperative direct measurement of left ventricular outflow tract gradients to guide surgical myectomy for hypertrophic cardiomyopathy. In: Journal of Thoracic and Cardiovascular Surgery. 2011 ; Vol. 142, No. 1. pp. 53-59.
@article{5e9181a7ed4f47baa2bb5b9dac447fc1,
title = "Intraoperative direct measurement of left ventricular outflow tract gradients to guide surgical myectomy for hypertrophic cardiomyopathy",
abstract = "Objectives: We sought to summarize our recent experience with intraoperative monitoring for management of patients undergoing surgical myectomy for hypertrophic obstructive cardiomyopathy with emphasis on dynamic left ventricular outflow tract obstruction. We also analyzed the impact of these data on surgical decision-making and adequacy of septal myectomy. Methods: We retrospectively analyzed the medical records of 198 patients who underwent transaortic septal myectomy and evaluated baseline and provoked left ventricular outflow tract gradients obtained by Doppler echocardiography and by direct measurement of pressures in the left ventricle and aorta. Results: After induction of anesthesia before myectomy, left ventricular outflow tract obstruction, assessed by direct measurement, was less than the gradient documented by preoperative Doppler echocardiography in 119 patients (60{\%}) (41 ± 31 vs 76 ± 40 mm Hg; P < .001). In 75 patients (38{\%}), the obstruction was more severe (64 ± 32 vs 35 ± 31 mm Hg; P < .001); 4 patients (2{\%}) had similar left ventricular outflow tract gradients. After myectomy, left ventricular outflow tract gradient decreased markedly (49 ± 33 vs 4 ± 8 mm Hg [P < .001] by direct measurement; 59 ± 42 vs 4 ± 6 mm Hg [P < .001] by transesophageal echocardiography). Cardiopulmonary bypass was resumed for more extensive myectomy in 8 (4{\%}) patients because of a persistent residual left ventricular outflow tract gradient of 33 ± 14 mm Hg. Of note, for 78 patients (39{\%}) intraoperative Doppler echocardiographic assessment of left ventricular outflow tract gradient was technically inadequate. Conclusions: Direct intraoperative measurement of pressures in the left ventricle and aorta provides important hemodynamic data in addition to intraoperative transesophageal echocardiography findings. This information assists the surgeon in defining the extent of myectomy.",
author = "Ashikhmina, {Elena A.} and Schaff, {Hartzell V} and Ommen, {Steve R.} and Dearani, {Joseph A.} and Nishimura, {Rick A.} and Abel, {Martin D.}",
year = "2011",
month = "7",
doi = "10.1016/j.jtcvs.2010.08.011",
language = "English (US)",
volume = "142",
pages = "53--59",
journal = "Journal of Thoracic and Cardiovascular Surgery",
issn = "0022-5223",
publisher = "Mosby Inc.",
number = "1",

}

TY - JOUR

T1 - Intraoperative direct measurement of left ventricular outflow tract gradients to guide surgical myectomy for hypertrophic cardiomyopathy

AU - Ashikhmina, Elena A.

AU - Schaff, Hartzell V

AU - Ommen, Steve R.

AU - Dearani, Joseph A.

AU - Nishimura, Rick A.

AU - Abel, Martin D.

PY - 2011/7

Y1 - 2011/7

N2 - Objectives: We sought to summarize our recent experience with intraoperative monitoring for management of patients undergoing surgical myectomy for hypertrophic obstructive cardiomyopathy with emphasis on dynamic left ventricular outflow tract obstruction. We also analyzed the impact of these data on surgical decision-making and adequacy of septal myectomy. Methods: We retrospectively analyzed the medical records of 198 patients who underwent transaortic septal myectomy and evaluated baseline and provoked left ventricular outflow tract gradients obtained by Doppler echocardiography and by direct measurement of pressures in the left ventricle and aorta. Results: After induction of anesthesia before myectomy, left ventricular outflow tract obstruction, assessed by direct measurement, was less than the gradient documented by preoperative Doppler echocardiography in 119 patients (60%) (41 ± 31 vs 76 ± 40 mm Hg; P < .001). In 75 patients (38%), the obstruction was more severe (64 ± 32 vs 35 ± 31 mm Hg; P < .001); 4 patients (2%) had similar left ventricular outflow tract gradients. After myectomy, left ventricular outflow tract gradient decreased markedly (49 ± 33 vs 4 ± 8 mm Hg [P < .001] by direct measurement; 59 ± 42 vs 4 ± 6 mm Hg [P < .001] by transesophageal echocardiography). Cardiopulmonary bypass was resumed for more extensive myectomy in 8 (4%) patients because of a persistent residual left ventricular outflow tract gradient of 33 ± 14 mm Hg. Of note, for 78 patients (39%) intraoperative Doppler echocardiographic assessment of left ventricular outflow tract gradient was technically inadequate. Conclusions: Direct intraoperative measurement of pressures in the left ventricle and aorta provides important hemodynamic data in addition to intraoperative transesophageal echocardiography findings. This information assists the surgeon in defining the extent of myectomy.

AB - Objectives: We sought to summarize our recent experience with intraoperative monitoring for management of patients undergoing surgical myectomy for hypertrophic obstructive cardiomyopathy with emphasis on dynamic left ventricular outflow tract obstruction. We also analyzed the impact of these data on surgical decision-making and adequacy of septal myectomy. Methods: We retrospectively analyzed the medical records of 198 patients who underwent transaortic septal myectomy and evaluated baseline and provoked left ventricular outflow tract gradients obtained by Doppler echocardiography and by direct measurement of pressures in the left ventricle and aorta. Results: After induction of anesthesia before myectomy, left ventricular outflow tract obstruction, assessed by direct measurement, was less than the gradient documented by preoperative Doppler echocardiography in 119 patients (60%) (41 ± 31 vs 76 ± 40 mm Hg; P < .001). In 75 patients (38%), the obstruction was more severe (64 ± 32 vs 35 ± 31 mm Hg; P < .001); 4 patients (2%) had similar left ventricular outflow tract gradients. After myectomy, left ventricular outflow tract gradient decreased markedly (49 ± 33 vs 4 ± 8 mm Hg [P < .001] by direct measurement; 59 ± 42 vs 4 ± 6 mm Hg [P < .001] by transesophageal echocardiography). Cardiopulmonary bypass was resumed for more extensive myectomy in 8 (4%) patients because of a persistent residual left ventricular outflow tract gradient of 33 ± 14 mm Hg. Of note, for 78 patients (39%) intraoperative Doppler echocardiographic assessment of left ventricular outflow tract gradient was technically inadequate. Conclusions: Direct intraoperative measurement of pressures in the left ventricle and aorta provides important hemodynamic data in addition to intraoperative transesophageal echocardiography findings. This information assists the surgeon in defining the extent of myectomy.

UR - http://www.scopus.com/inward/record.url?scp=79959369401&partnerID=8YFLogxK

UR - http://www.scopus.com/inward/citedby.url?scp=79959369401&partnerID=8YFLogxK

U2 - 10.1016/j.jtcvs.2010.08.011

DO - 10.1016/j.jtcvs.2010.08.011

M3 - Article

C2 - 20884022

AN - SCOPUS:79959369401

VL - 142

SP - 53

EP - 59

JO - Journal of Thoracic and Cardiovascular Surgery

JF - Journal of Thoracic and Cardiovascular Surgery

SN - 0022-5223

IS - 1

ER -