Surgical pathology of subaortic septal myectomy associated with hypertrophic cardiomyopathy

A study of 204 cases (1996-2000)

Geoffrey T. Lamke, Rachel D. Allen, William D. Edwards, Henry D. Tazelaar, Gordon K. Danielson

Research output: Contribution to journalArticle

44 Citations (Scopus)

Abstract

Background: No large surgical series have qualitatively examined all histopathologic features of hypertrophic cardiomyopathy (HCM). Methods: Medical records and microscopic slides were reviewed from 204 patients undergoing septal myectomy for HCM at Mayo Clinic Rochester. Results: The 108 females and 96 males (1-86 years old; mean, 48) included 133 patients <60 years old (Group 1) and 71 patients ≥60 years (Group 2). Clinical features more prevalent in Group 2 than in Group 1 included female gender (68% vs. 45%; P=.003), aortic valve disease (31% vs. 12%; P=.01) and severe coronary atherosclerosis (43% vs. 9%; P=.001). Overall, microscopic abnormalities included myocyte hypertrophy (100%), endocardial (96%) and myocardial (93%) fibrosis, myocyte disarray (79%) and vacuolization (60%), endocardial inflammation (48%), arterial thickening (46%), dilated venules (28%), arterial dysplasia (16%), left bundle branch tissue (12%), infarction (2%), endocardial (1%) and myocardial (<1%) calcium, and amyloid (1%; senile type in all three). Lesions more prevalent in Group 1 than Group 2 were vacuolization (68% vs. 45%; P=.002), disarray (87% vs. 65%; P=.0003) and dilated venules (33% vs. 18%; P=.02). In contrast, lesions more frequent in Group 2 than in Group 1 included left bundle branch (20% vs. 8%; P=.02) and amyloid and endocardial calcium (4% vs. 0%; P=.04, each). Conclusions: Among patients undergoing septal myectomy for HCM, 53% were women and 35% were ≥60 years old. The most common microscopic features were hypertrophy, disarray, fibrosis, inflammation and vascular alterations. Disarray cannot be used as a morphologic hallmark for HCM in small surgical myectomy specimens because it was absent in 21% of the patients. Because amyloid unexpectedly affected three elderly patients, routine amyloid staining is recommended for patients ≥65 years old.

Original languageEnglish (US)
Pages (from-to)149-158
Number of pages10
JournalCardiovascular Pathology
Volume12
Issue number3
DOIs
StatePublished - May 2003

Fingerprint

Surgical Pathology
Hypertrophic Cardiomyopathy
Amyloid
Venules
Muscle Cells
Hypertrophy
Fibrosis
Calcium
Arteritis
Aortic Diseases
Aortic Valve
Infarction
Medical Records
Blood Vessels
Coronary Artery Disease
Staining and Labeling
Inflammation

Keywords

  • Amyloidosis
  • Hypertrophic cardiomyopathy
  • Septal myectomy
  • Surgical pathology

ASJC Scopus subject areas

  • Cardiology and Cardiovascular Medicine
  • Pathology and Forensic Medicine

Cite this

Surgical pathology of subaortic septal myectomy associated with hypertrophic cardiomyopathy : A study of 204 cases (1996-2000). / Lamke, Geoffrey T.; Allen, Rachel D.; Edwards, William D.; Tazelaar, Henry D.; Danielson, Gordon K.

In: Cardiovascular Pathology, Vol. 12, No. 3, 05.2003, p. 149-158.

Research output: Contribution to journalArticle

Lamke, Geoffrey T. ; Allen, Rachel D. ; Edwards, William D. ; Tazelaar, Henry D. ; Danielson, Gordon K. / Surgical pathology of subaortic septal myectomy associated with hypertrophic cardiomyopathy : A study of 204 cases (1996-2000). In: Cardiovascular Pathology. 2003 ; Vol. 12, No. 3. pp. 149-158.
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abstract = "Background: No large surgical series have qualitatively examined all histopathologic features of hypertrophic cardiomyopathy (HCM). Methods: Medical records and microscopic slides were reviewed from 204 patients undergoing septal myectomy for HCM at Mayo Clinic Rochester. Results: The 108 females and 96 males (1-86 years old; mean, 48) included 133 patients <60 years old (Group 1) and 71 patients ≥60 years (Group 2). Clinical features more prevalent in Group 2 than in Group 1 included female gender (68{\%} vs. 45{\%}; P=.003), aortic valve disease (31{\%} vs. 12{\%}; P=.01) and severe coronary atherosclerosis (43{\%} vs. 9{\%}; P=.001). Overall, microscopic abnormalities included myocyte hypertrophy (100{\%}), endocardial (96{\%}) and myocardial (93{\%}) fibrosis, myocyte disarray (79{\%}) and vacuolization (60{\%}), endocardial inflammation (48{\%}), arterial thickening (46{\%}), dilated venules (28{\%}), arterial dysplasia (16{\%}), left bundle branch tissue (12{\%}), infarction (2{\%}), endocardial (1{\%}) and myocardial (<1{\%}) calcium, and amyloid (1{\%}; senile type in all three). Lesions more prevalent in Group 1 than Group 2 were vacuolization (68{\%} vs. 45{\%}; P=.002), disarray (87{\%} vs. 65{\%}; P=.0003) and dilated venules (33{\%} vs. 18{\%}; P=.02). In contrast, lesions more frequent in Group 2 than in Group 1 included left bundle branch (20{\%} vs. 8{\%}; P=.02) and amyloid and endocardial calcium (4{\%} vs. 0{\%}; P=.04, each). Conclusions: Among patients undergoing septal myectomy for HCM, 53{\%} were women and 35{\%} were ≥60 years old. The most common microscopic features were hypertrophy, disarray, fibrosis, inflammation and vascular alterations. Disarray cannot be used as a morphologic hallmark for HCM in small surgical myectomy specimens because it was absent in 21{\%} of the patients. Because amyloid unexpectedly affected three elderly patients, routine amyloid staining is recommended for patients ≥65 years old.",
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AB - Background: No large surgical series have qualitatively examined all histopathologic features of hypertrophic cardiomyopathy (HCM). Methods: Medical records and microscopic slides were reviewed from 204 patients undergoing septal myectomy for HCM at Mayo Clinic Rochester. Results: The 108 females and 96 males (1-86 years old; mean, 48) included 133 patients <60 years old (Group 1) and 71 patients ≥60 years (Group 2). Clinical features more prevalent in Group 2 than in Group 1 included female gender (68% vs. 45%; P=.003), aortic valve disease (31% vs. 12%; P=.01) and severe coronary atherosclerosis (43% vs. 9%; P=.001). Overall, microscopic abnormalities included myocyte hypertrophy (100%), endocardial (96%) and myocardial (93%) fibrosis, myocyte disarray (79%) and vacuolization (60%), endocardial inflammation (48%), arterial thickening (46%), dilated venules (28%), arterial dysplasia (16%), left bundle branch tissue (12%), infarction (2%), endocardial (1%) and myocardial (<1%) calcium, and amyloid (1%; senile type in all three). Lesions more prevalent in Group 1 than Group 2 were vacuolization (68% vs. 45%; P=.002), disarray (87% vs. 65%; P=.0003) and dilated venules (33% vs. 18%; P=.02). In contrast, lesions more frequent in Group 2 than in Group 1 included left bundle branch (20% vs. 8%; P=.02) and amyloid and endocardial calcium (4% vs. 0%; P=.04, each). Conclusions: Among patients undergoing septal myectomy for HCM, 53% were women and 35% were ≥60 years old. The most common microscopic features were hypertrophy, disarray, fibrosis, inflammation and vascular alterations. Disarray cannot be used as a morphologic hallmark for HCM in small surgical myectomy specimens because it was absent in 21% of the patients. Because amyloid unexpectedly affected three elderly patients, routine amyloid staining is recommended for patients ≥65 years old.

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