TY - JOUR
T1 - Surgical pathology of subaortic septal myectomy not associated with hypertrophic cardiomyopathy
T2 - A study of 98 cases (1996-2000)
AU - Allen, Rachel D.
AU - Edwards, William D.
AU - Tazelaar, Henry D.
AU - Danielson, Gordon K.
N1 - Funding Information:
This work was supported in part by the Howard B. Burchell 2002 Scholarship (Ms. Allen) from the Northland Affiliate of the American Heart Association.
PY - 2003
Y1 - 2003
N2 - 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.
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.
KW - Amyloidosis
KW - Aortic stenosis
KW - Congenital subaortic stenosis
KW - Septal myectomy
KW - Shone syndrome
KW - Surgical pathology
UR - http://www.scopus.com/inward/record.url?scp=0038798425&partnerID=8YFLogxK
UR - http://www.scopus.com/inward/citedby.url?scp=0038798425&partnerID=8YFLogxK
U2 - 10.1016/S1054-8807(03)00057-7
DO - 10.1016/S1054-8807(03)00057-7
M3 - Article
C2 - 12826290
AN - SCOPUS:0038798425
SN - 1054-8807
VL - 12
SP - 207
EP - 215
JO - Cardiovascular Pathology
JF - Cardiovascular Pathology
IS - 4
ER -