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

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Presentation transcript:

Hypertrophic cardiomyopathy: New approaches and a time to reappraise older approaches Hiroo Takayama, MD, PhD, Wendy K. Chung, MD, PhD, Mathew S. Maurer, MD, Jonathan N. Ginns, MD The Journal of Thoracic and Cardiovascular Surgery Volume 152, Issue 4, Pages 983-988 (October 2016) DOI: 10.1016/j.jtcvs.2016.06.034 Copyright © 2016 The American Association for Thoracic Surgery Terms and Conditions

Figure 1 Mutations in myosin that increase power generation lead to hypertrophic cardiomyopathy (HCM). In a mouse model of HCM, early intervention with a small-molecule inhibitor of myosin reverses the disease (hypothetical patient scenario is shown). Such intervention could simplify treatment and become a generalized approach to control many contractile protein mutations that lead to HCM, or the use of myosin activators for dilated cardiomyopathy. (Adapted with permission from Warshaw,7 Copyright © The American Association for the Advancement of Science.) The Journal of Thoracic and Cardiovascular Surgery 2016 152, 983-988DOI: (10.1016/j.jtcvs.2016.06.034) Copyright © 2016 The American Association for Thoracic Surgery Terms and Conditions

Figure 2 Two operative approaches for performing septal myectomy in obstructive HCM. A (right insert), Typical outflow tract morphology with predominant basal septal hypertrophy and subaortic obstruction caused primarily by systolic anterior motion of the mitral valve. Endocardial thickening at the line of apposition of the anterior mitral leaflet to the septum (friction lesion) can be seen. A (left insert), A standard rectangular myectomy trough (Morrow procedure) is created from 1 cm below the aortic valve apically to a point beyond the line of the mitral–septal contact and intraventricular obstruction, allowing relief of the outflow tract gradient and preservation of the sinus rhythm. B, In the presence of a muscular midcavity obstruction caused by anomalous papillary muscles with direct insertion into the mitral valve or by extensive diffuse septal hypertrophy extending to the bases of the papillary muscles, a much more substantial myectomy is performed by combining the standard operation with an extended midventricular resection. The apical portion of the myectomy trough is much wider and includes the distal third of the right side of the septum. (Adapted with permission from Dearani et al,13 Copyright © Nature Publishing Group.) The Journal of Thoracic and Cardiovascular Surgery 2016 152, 983-988DOI: (10.1016/j.jtcvs.2016.06.034) Copyright © 2016 The American Association for Thoracic Surgery Terms and Conditions

HCM program discussion on 3D printed heart. The Journal of Thoracic and Cardiovascular Surgery 2016 152, 983-988DOI: (10.1016/j.jtcvs.2016.06.034) Copyright © 2016 The American Association for Thoracic Surgery Terms and Conditions