Surgery for hypertrophic obstructive cardiomyopathy (HOCM): The extended transaortic subvalvular myectomy (TSM) approach Hagen D. Schulte, MD, Wolfgang.

Slides:

Advertisements

Similar presentations

Benjamin B. Peeler, MD, Irving L. Kron, MD

Advertisements

Extended myectomy for hypertrophic obstructive cardiomyopathy

Reinforcement of the Pulmonary Autograft with a Prosthetic Graft to Prevent Dilatation After the Ross Procedure Thierry Carrel, MD, Florian Schönhoff,

Septal myectomy for obstructive hypertrophic cardiomyopathy

Valve-Sparing Konno and Hypertrophic Obstructive Cardiomyopathy in Children Pascal R. Vouhé, MD, PhD Operative Techniques in Thoracic and Cardiovascular.

Gaetano Rocco, MD, FRCSEd

Pacopexy: Restoration Procedure for Nonischemic Dilated Cardiomyopathy

The Arterial Switch Procedure: Closed Coronary Artery Transfer

Transventricular Repair of Tetralogy of Fallot

Surgical Correction of Congenital Supravalvular Aortic Stenosis

Surgical Management of Congenital Mitral Stenosis

King of Hearts for Ace of Spades: Apical Hypertrophic Cardiomyopathy

Combined anterior mitral leaflet extension and spark erosion myectomy in hypertrophic obstructive cardiomyopathy: Echo-enhanced surgery Lex A. van Herwerden,

Prevalence and clinical significance of acquired left coronary artery fistulas after surgical myectomy in patients with hypertrophic cardiomyopathy Aurelio.

Modified Konno Procedure for Left Ventricular Outflow Tract Obstruction David P. Bichell, MD Operative Techniques in Thoracic and Cardiovascular Surgery

George M. Alfieris, MD, Michael F. Swartz, PhD

Surgical and Pathological Anatomy of the Aortic Valve and Root

Repair of Intramural Coronary Artery in Anomalous Aortic Origin of a Coronary Artery Yasuhiro Kotani, MD, PhD, Shunji Sano, MD, PhD, Shingo Kasahara,

Basal cusp enlargement for repair of aortic valve insufficiency

Resection of Discrete Subaortic Membranes

Repair Techniques for Ischemic Mitral Regurgitation

Hypertrophic Cardiomyopathy in Childhood: Disease Natural History, Impact of Obstruction, and Its Influence on Survival Edward J. Hickey, MD, Brian W.

Septal Myectomy Results in Regression of Left Ventricular Hypertrophy in Patients With Hypertrophic Obstructive Cardiomyopathy Subrato J. Deb, MD, Hartzell.

Obstructive hypertrophic cardiomyopathy: echocardiography, pathophysiology, and the continuing evolution of surgery for obstruction Mark V Sherrid, MD,

Benjamin B. Peeler, MD, Irving L. Kron, MD

Beating-heart, off-pump mitral valve repair by implantation of artificial chordae tendineae: An acute in vivo animal study Pietro Bajona, MD, William.

Idiopathic Hypertrophic Subaortic Septal Obstruction: Robotic Transatrial and Transmitral Ventricular Septal Resection W. Randolph Chitwood, MD, FACS,

William G. Williams, MD, Igor E. Konstantinov, MD

Dehiscence of aortic valve commissure complicated by aortic regurgitation Toshihiro Fukui, MD, Tomoki Shimokawa, MD, Ken-u Fumimoto, MD, Susumu Mananbe,

Beyond Extended Myectomy for Hypertrophic Cardiomyopathy: The Resection- Plication-Release (RPR) Repair Sandhya K. Balaram, MD, PhD, Mark V. Sherrid,

Exercise gas exchange analysis in obstructive hypertrophic cardiomyopathy before and after myectomy (cardiopulmonary exercise test combined with exercise-

Myectomy and mitral repair through the left atrium in hypertrophic obstructive cardiomyopathy: The preferred approach for contemporary surgical candidates?

Surgical treatment of residual systolic anterior motion after otherwise successful percutaneous transluminal septal myocardial ablation: A case report

Scan, plan, print, practice, perform: Development and use of a patient-specific 3- dimensional printed model in adult cardiac surgery Joshua L. Hermsen,

Dilated cardiomyopathy and functional mitral regurgitation complicated with traumatic ventricular septal defect Hisato Ito, MD, Kiyohito Yamamoto, MD,

Endocarditis with Involvement of the Aorto-Mitral Curtain

Accessory mitral valve tissue causing severe left ventricular outflow tract obstruction in an adult Yoshikazu Aoka, MD, Naoko Ishizuka, MD, PhD, Yasunari.

Mitral Valve Replacement With Homograft

Chordal Preservation in Mitral Valve Replacement

Transatrial and transmitral myectomy for hypertrophic obstructive cardiomyopathy of the left ventricle Hikaru Matsuda, MD Operative Techniques in Thoracic.

Subaortic stenosis in the spectrum of atrioventricular septal defects

Transmitral Septal Myectomy for Hypertrophic Obstructive Cardiomyopathy Brody Wehman, MD, Mehrdad Ghoreishi, MD, Nathaniel Foster, BS, Libin Wang, MD,

Aortic Valve Insufficiency: Leaflet Reconstruction Techniques

Hiroo Takayama, MD, PhD, Wendy K. Chung, MD, PhD, Mathew S

Robot-assisted septal myectomy for hypertrophic cardiomyopathy with left ventricular outflow tract obstruction Zain Khalpey, MD, PhD, MRCS (Eng), Lev.

A new concept for correction of systolic anterior motion and mitral valve regurgitation in patients with hypertrophic obstructive cardiomyopathy Joerg.

Intermediate-term results of a nonresectional dynamic repair technique in 662 patients with mitral valve prolapse and mitral regurgitation Gerald M.

Anatomic correction of the syndrome of prolapsing right coronary aortic cusp, dilatation of the sinus of valsalva, and ventricular septal defect Magdi.

Commissural Closure for Repair of Mitral Commissural Prolapse

Subvalvular aortic stenosis: Comprehensive cardiac evaluation with dual-source computed tomography Paul Stolzmann, MD, Hans Scheffel, MD, Dominique Bettex,

Patch Enlargement of the Aortic Annulus using the Manouguian Technique

Acute hemodynamic effects of restrictive mitral annuloplasty in patients with end-stage heart failure: Analysis by pressure-volume relations Sven A.F.

Surgical relief of left ventricular outflow obstruction in pediatric hypertrophic cardiomyopathy: The need for a tailored approach John M. Karamichalis,

Barlow disease: Simple and complex

Apical myectomy: A new surgical technique for management of severely symptomatic patients with apical hypertrophic cardiomyopathy Hartzell V. Schaff,

Bulging Subaortic Septum: An Important Risk Factor for Systolic Anterior Motion After Mitral Valve Repair Sameh M. Said, MD, Hartzell V. Schaff, MD,

AORTIC VALVE–PRESERVING PROCEDURE FOR ENLARGEMENT OF THE LEFT VENTRICULAR OUTFLOW TRACT AND MITRAL ANULUS Richard A. Jonas, MD, John F. Keane, MD, James.

Technique of Aortic Translocation for the Management of Transposition of the Great Arteries with a Ventricular Septal Defect and Pulmonary Stenosis Victor.

Physiologic left ventricular reconstruction: Shape, function, and time recaptured Gerald D. Buckberg, MD The Journal of Thoracic and Cardiovascular Surgery

Intraventricular mitral annuloplasty technique for use with repair of posterior left ventricular aneurysm Igor Konstantinov, MDa, Lynda L. Mickleborough,

Extended septal myectomy for hypertrophic obstructive cardiomyopathy with anomalous mitral papillary muscles or chordae Kenji Minakata, MD, Joseph A.

Mitral Valve Implantation

Complete excision of secondary chordae of the anterior mitral leaflet as an adjunct in surgical management of hypertrophic obstructive cardiomyopathy.

Shaun P. Setty, MD, John L. Bass, MD, K. P

Relationship between left ventricular mass, wall thickness, and survival after subaortic septal myectomy for hypertrophic obstructive cardiomyopathy

Filip Casselman, MD, PhD, FETCS, Hugo Vanermen, MD, FETCS

Michael H. Hines, MD, Neal D. Kon, MD The Annals of Thoracic Surgery

Surgical techniques for posterior aortic root enlargement

David A. Theodoro, MDa, Gordon K. Danielson, MDa, Robert H

Septal myectomy for obstructive hypertrophic cardiomyopathy

Presentation transcript:

Surgery for hypertrophic obstructive cardiomyopathy (HOCM): The extended transaortic subvalvular myectomy (TSM) approach Hagen D. Schulte, MD, Wolfgang H. Bircks, MD Operative Techniques in Thoracic and Cardiovascular Surgery Volume 9, Issue 4, Pages 293-303 (December 2004) DOI: 10.1053/j.optechstcvs.2004.11.002 Copyright © 2004 Elsevier Inc. Terms and Conditions

Figure 1 HOCM: Pathophysiological consequences (Wigle and co-workers2). Operative Techniques in Thoracic and Cardiovascular Surgery 2004 9, 293-303DOI: (10.1053/j.optechstcvs.2004.11.002) Copyright © 2004 Elsevier Inc. Terms and Conditions

Figure 2 HOCM: Consequences on morphology and geometry (van der Wall3). Operative Techniques in Thoracic and Cardiovascular Surgery 2004 9, 293-303DOI: (10.1053/j.optechstcvs.2004.11.002) Copyright © 2004 Elsevier Inc. Terms and Conditions

Figure 3 Bigelow—incision and extension of subvalvular myectomy [modified after Morrow4,5 and Bigelow7 from nadir of RCC to commissure of RCC and LCC (From Herz-,Thorax-, Gefaesschir. 2151, 1988)]. Operative Techniques in Thoracic and Cardiovascular Surgery 2004 9, 293-303DOI: (10.1053/j.optechstcvs.2004.11.002) Copyright © 2004 Elsevier Inc. Terms and Conditions

Figure 4 Schematic survey of intraventricular extension of subvalvular, midventricular, and lateral LV wall hypertrophy (modified from AE Becker, RH Anderson: Cardiac Pathol 198312). (Color version of figure is available online at http://www.us.elsevierhealth.com/optechstcvs.) Operative Techniques in Thoracic and Cardiovascular Surgery 2004 9, 293-303DOI: (10.1053/j.optechstcvs.2004.11.002) Copyright © 2004 Elsevier Inc. Terms and Conditions

Figure 5 Specially designed set of angled instruments to improve the sight into the reduced LVOT for the surgeon. (Color version of figure is available online at http://www.us.elsevierhealth.com/optechstcvs.) Operative Techniques in Thoracic and Cardiovascular Surgery 2004 9, 293-303DOI: (10.1053/j.optechstcvs.2004.11.002) Copyright © 2004 Elsevier Inc. Terms and Conditions

Figure 6 Preoperative pressure tracings with a normal beating heart (left) and after a ventricular extrasystolic beat (right) demonstrating pathological high gradients (upper graphs a1, a2) postoperatively after myectomy with considerably reduced gradients (lower graphs b1, b2). (From: Progress in Cardiology 2/2, 192, 1989.) Operative Techniques in Thoracic and Cardiovascular Surgery 2004 9, 293-303DOI: (10.1053/j.optechstcvs.2004.11.002) Copyright © 2004 Elsevier Inc. Terms and Conditions

Figure 7 View into the LVOT. (A) Narrowed LVOT with bulging subvalvular hypertrophied septum. (B) Bulging of the mitral chordae crossing a hypertrophied part of the left LV wall. (Color version of figure is available online at http://www.us.elsevierhealth.com/optechstcvs.) Operative Techniques in Thoracic and Cardiovascular Surgery 2004 9, 293-303DOI: (10.1053/j.optechstcvs.2004.11.002) Copyright © 2004 Elsevier Inc. Terms and Conditions

Figure 8 Transaortic subvalvular incisions preparing myectomy. (A) Schematic extension of subvalvular first incision near the nadir of RCC in direction to LV apex. (B) Second incision below the commissure between RCC and LCC parallel to the LCC in direction to the LVOT (modified combined Morrow-Bigelow incisions). (C) Intraoperative view: First incision and second incision (dotted line). (D) Performed first and second incisions, the flexible spatulum retains safely the chordae of the anterior mitral leaflet in the lower LVOT. (E) Third incision parallel to the left part of the RCC leaving a rim of about 1 to 1.5 mm of subvalvular myocardium. The partly excised myocardium is fixed with a broad-headed forceps to ameliorate the myectomy in direction to the apex and the residual LV cavity. (F) Extent of the primary part of TSM which has to be further continued downwards into the LV. (Color version of figure is available online at http://www.us.elsevierhealth.com/optechstcvs.) Operative Techniques in Thoracic and Cardiovascular Surgery 2004 9, 293-303DOI: (10.1053/j.optechstcvs.2004.11.002) Copyright © 2004 Elsevier Inc. Terms and Conditions

Figure 9 View into the effectively enlarged LVOT after retraction of the aortic cusps. (Color version of figure is available online at http://www.us.elsevierhealth.com/optechstcvs.) Operative Techniques in Thoracic and Cardiovascular Surgery 2004 9, 293-303DOI: (10.1053/j.optechstcvs.2004.11.002) Copyright © 2004 Elsevier Inc. Terms and Conditions

Figure 10 Control of the aortic cusps after the instrumental and surgical manipulations before closure of the oblique aortic incision. (Color version of figure is available online at http://www.us.elsevierhealth.com/optechstcvs.) Operative Techniques in Thoracic and Cardiovascular Surgery 2004 9, 293-303DOI: (10.1053/j.optechstcvs.2004.11.002) Copyright © 2004 Elsevier Inc. Terms and Conditions

Figure 11 HOCM: Pathophysiological consequences after considerable surgical relief of the LVOTO and of mitral regurgitation. Operative Techniques in Thoracic and Cardiovascular Surgery 2004 9, 293-303DOI: (10.1053/j.optechstcvs.2004.11.002) Copyright © 2004 Elsevier Inc. Terms and Conditions