Surgical pathology of subaortic septal myectomy not associated with hypertrophic cardiomyopathy: A study of 98 cases (1996-2000)

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

Research output: Contribution to journalArticle

18 Citations (Scopus)

Abstract

Background: No series have described the surgical pathology of subaortic septal myectomy in patients with conditions other than hypertrophic cardiomyopathy (HCM). Methods: Medical records and microscopic slides were reviewed from 98 non-HCM patients undergoing septal myectomy at Mayo Clinic Rochester from 1996 to 2000. Concurrently, 204 other patients had myectomy for HCM. Results: The study group (65 women, 33 men) ranged in age from 1.5 to 92 years (mean, 61). Seventy underwent surgery for aortic stenosis (Group 1), 25 for congenital subaortic stenosis (Group 2) and 3 for other conditions (Group 3). Group 1 patients were older than Group 2 patients (72 vs. 26 years; P<.0001). Microscopic evaluation showed myocyte hypertrophy (97%), vacuolization (35%), left bundle branch tissue (26%) (33% in Group 1 vs. 8% in Group 2; P=.02) and disarray (19%); interstitial fibrosis (92%), inflammation (10%) and amyloidosis (7%, all prealbumin type, all Group 1, >80 years old); arterial thickening (18%) and dysplasia (12%), and dilated venules (6%); and endocardial fibrosis (74%) (64% in Group 1 vs. 100% in Group 2; P=.0001) and chronic inflammation (17%). Conclusions: Of 302 patients undergoing subaortic septal myectomy, 32% had conditions other than HCM. Myocyte disarray was present in 19% of patients without HCM (and was absent in 21% of HCM patients in a companion study). Thus, disarray alone cannot be used reliably to include or exclude a diagnosis of HCM in small surgical specimens. Because amyloid was found unexpectedly in seven elderly patients, we recommend routine amyloid staining on surgical myectomy tissue from patients ≥65 years old.

Original languageEnglish (US)
Pages (from-to)207-215
Number of pages9
JournalCardiovascular Pathology
Volume12
Issue number4
DOIs
StatePublished - Jul 2003

Fingerprint

Surgical Pathology
Hypertrophic Cardiomyopathy
Amyloid
Venules
Aortic Valve Stenosis
Cardiomyopathies
Muscle Cells
Medical Records
Pathologic Constriction
Fibrosis
Staining and Labeling
Inflammation

Keywords

  • Amyloidosis
  • Aortic stenosis
  • Congenital subaortic stenosis
  • Septal myectomy
  • Shone syndrome
  • Surgical pathology

ASJC Scopus subject areas

  • Cardiology and Cardiovascular Medicine
  • Pathology and Forensic Medicine

Cite this

Surgical pathology of subaortic septal myectomy not associated with hypertrophic cardiomyopathy : A study of 98 cases (1996-2000). / Allen, Rachel D.; Edwards, William D.; Tazelaar, Henry D.; Danielson, Gordon K.

In: Cardiovascular Pathology, Vol. 12, No. 4, 07.2003, p. 207-215.

Research output: Contribution to journalArticle

Allen, Rachel D. ; Edwards, William D. ; Tazelaar, Henry D. ; Danielson, Gordon K. / Surgical pathology of subaortic septal myectomy not associated with hypertrophic cardiomyopathy : A study of 98 cases (1996-2000). In: Cardiovascular Pathology. 2003 ; Vol. 12, No. 4. pp. 207-215.
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abstract = "Background: No series have described the surgical pathology of subaortic septal myectomy in patients with conditions other than hypertrophic cardiomyopathy (HCM). Methods: Medical records and microscopic slides were reviewed from 98 non-HCM patients undergoing septal myectomy at Mayo Clinic Rochester from 1996 to 2000. Concurrently, 204 other patients had myectomy for HCM. Results: The study group (65 women, 33 men) ranged in age from 1.5 to 92 years (mean, 61). Seventy underwent surgery for aortic stenosis (Group 1), 25 for congenital subaortic stenosis (Group 2) and 3 for other conditions (Group 3). Group 1 patients were older than Group 2 patients (72 vs. 26 years; P<.0001). Microscopic evaluation showed myocyte hypertrophy (97{\%}), vacuolization (35{\%}), left bundle branch tissue (26{\%}) (33{\%} in Group 1 vs. 8{\%} in Group 2; P=.02) and disarray (19{\%}); interstitial fibrosis (92{\%}), inflammation (10{\%}) and amyloidosis (7{\%}, all prealbumin type, all Group 1, >80 years old); arterial thickening (18{\%}) and dysplasia (12{\%}), and dilated venules (6{\%}); and endocardial fibrosis (74{\%}) (64{\%} in Group 1 vs. 100{\%} in Group 2; P=.0001) and chronic inflammation (17{\%}). Conclusions: Of 302 patients undergoing subaortic septal myectomy, 32{\%} had conditions other than HCM. Myocyte disarray was present in 19{\%} of patients without HCM (and was absent in 21{\%} of HCM patients in a companion study). Thus, disarray alone cannot be used reliably to include or exclude a diagnosis of HCM in small surgical specimens. Because amyloid was found unexpectedly in seven elderly patients, we recommend routine amyloid staining on surgical myectomy tissue from patients ≥65 years old.",
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AU - Danielson, Gordon K.

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AB - Background: No series have described the surgical pathology of subaortic septal myectomy in patients with conditions other than hypertrophic cardiomyopathy (HCM). Methods: Medical records and microscopic slides were reviewed from 98 non-HCM patients undergoing septal myectomy at Mayo Clinic Rochester from 1996 to 2000. Concurrently, 204 other patients had myectomy for HCM. Results: The study group (65 women, 33 men) ranged in age from 1.5 to 92 years (mean, 61). Seventy underwent surgery for aortic stenosis (Group 1), 25 for congenital subaortic stenosis (Group 2) and 3 for other conditions (Group 3). Group 1 patients were older than Group 2 patients (72 vs. 26 years; P<.0001). Microscopic evaluation showed myocyte hypertrophy (97%), vacuolization (35%), left bundle branch tissue (26%) (33% in Group 1 vs. 8% in Group 2; P=.02) and disarray (19%); interstitial fibrosis (92%), inflammation (10%) and amyloidosis (7%, all prealbumin type, all Group 1, >80 years old); arterial thickening (18%) and dysplasia (12%), and dilated venules (6%); and endocardial fibrosis (74%) (64% in Group 1 vs. 100% in Group 2; P=.0001) and chronic inflammation (17%). Conclusions: Of 302 patients undergoing subaortic septal myectomy, 32% had conditions other than HCM. Myocyte disarray was present in 19% of patients without HCM (and was absent in 21% of HCM patients in a companion study). Thus, disarray alone cannot be used reliably to include or exclude a diagnosis of HCM in small surgical specimens. Because amyloid was found unexpectedly in seven elderly patients, we recommend routine amyloid staining on surgical myectomy tissue from patients ≥65 years old.

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KW - Septal myectomy

KW - Shone syndrome

KW - Surgical pathology

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