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

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Presentation transcript:

Apical myectomy: A new surgical technique for management of severely symptomatic patients with apical hypertrophic cardiomyopathy Hartzell V. Schaff, MD, Morgan L. Brown, MD, Joseph A. Dearani, MD, Martin D. Abel, MD, Steve R. Ommen, MD, Paul Sorajja, MD, A. Jamil Tajik, MD, Rick A. Nishimura, MD The Journal of Thoracic and Cardiovascular Surgery Volume 139, Issue 3, Pages 634-640 (March 2010) DOI: 10.1016/j.jtcvs.2009.07.079 Copyright © 2010 Terms and Conditions

Figure 1 Pressure–volume loops in a patient with apical hypertrophic cardiomyopathy before (A) and after (B) surgical intervention. Pressure recordings were taken with high-fidelity micromanometer catheters (Millar Instruments, Houston, Tex); left ventricular volumes were calculated from contrast ventriculograms. Apical myectomy resulted in an increase in stroke volume (SV) and a larger left ventricular end-diastolic volume at lower end-diastolic pressure (EDP), suggesting improved left ventricular compliance after the operation. Preop, Preoperatively; Postop, postoperatively. The Journal of Thoracic and Cardiovascular Surgery 2010 139, 634-640DOI: (10.1016/j.jtcvs.2009.07.079) Copyright © 2010 Terms and Conditions

Figure 2 Cardiac magnetic resonance imaging demonstrates apical hypertrophic cardiomyopathy during diastole before (A) and after (B) apical myectomy that substantially enlarged the left ventricular cavity. The Journal of Thoracic and Cardiovascular Surgery 2010 139, 634-640DOI: (10.1016/j.jtcvs.2009.07.079) Copyright © 2010 Terms and Conditions

Figure 3 A and B, An incision made in the apex of the left ventricle (A) reveals the extensive muscle in the apex (B). C, Myectomy is performed to remove excess apical muscle. D, After myectomy, the incision is closed with felt strips. The Journal of Thoracic and Cardiovascular Surgery 2010 139, 634-640DOI: (10.1016/j.jtcvs.2009.07.079) Copyright © 2010 Terms and Conditions

Figure 4 Echocardiographic measurements of ejection fraction before and after apical myectomy. Mean values are presented with standard deviations. The P value was calculated for the change in mean ejection fraction. The Journal of Thoracic and Cardiovascular Surgery 2010 139, 634-640DOI: (10.1016/j.jtcvs.2009.07.079) Copyright © 2010 Terms and Conditions

Figure 5 A and B, Indexed left ventricular end-diastolic volume (LVEDV; A) and indexed left ventricular (LV) stroke volume (B) in 11 patients who had both preoperative and postoperative hemodynamic catheterization measurements. Mean values are presented with standard deviations. The P value was calculated for the change in mean indexed LVEDV and the change in indexed LV stroke volume. The Journal of Thoracic and Cardiovascular Surgery 2010 139, 634-640DOI: (10.1016/j.jtcvs.2009.07.079) Copyright © 2010 Terms and Conditions

Figure 6 The change in left ventricular end-diastolic pressure (LVEDP) on preoperative and postoperative hemodynamic catheterization. Mean values are presented with standard deviations. The P value was calculated for the change in mean LVEDP. The Journal of Thoracic and Cardiovascular Surgery 2010 139, 634-640DOI: (10.1016/j.jtcvs.2009.07.079) Copyright © 2010 Terms and Conditions

Figure 7 Kaplan–Meier curve of survival of patients after operations for apical hypertrophic cardiomyopathy. The Journal of Thoracic and Cardiovascular Surgery 2010 139, 634-640DOI: (10.1016/j.jtcvs.2009.07.079) Copyright © 2010 Terms and Conditions