Interdisciplinary approach to surgical treatment for patients with hypertrophic obstructive cardiomyopathy

Hypertrophic cardiomyopathy (HCM) – is the most common genetically determined heart disease, characterized by symmetrical or asymmetrical myocardial thickening (≥15 mm), leading to progressive failure and a high risk of sudden cardiac death (SCD). Diagnosis, natural course treatment HCM have become sources uncertainty, misunderstanding debate due increasing complexity diagnosis in clinical practice, international differences strategic approaches, advances genetic diseases imaging. The aim. To amplify current concept pathogenesis mechanisms left ventricular outflow tract (LVOT) obstruction as well highlight our own results surgical correction. Materials methods. A total 330 patients underwent correction (septal myectomy) National M. Amosov Institute Cardiovascular Surgery affiliated Academy Medical Sciences Ukraine. mean age was 49.7 ± 15.0 years, median 53; 168 (50.9 %) were male. Results. Surgical significantly improves quality life (80 % NYHA II functional class after correction), reduces symptoms (93 had minimal mitral regurgitation septal myectomy), decreases LVOT systolic pressure gradient (SPG) (the SPG 18.9 8.5 mmHg versus preoperative 93.6 23.2 mmHg) lowers high-risk for SCD percentage group 3.78 correction). Routine CT planning intraoperative transesophageal echocardiography helps avoid severe iatrogenic complications resect interventricular septum accurately possible, completely eliminating obstruction. Conclusions. Secondary abnormal chordal attachment cutting, papillary muscle realignment anterior leaflet plication along with myectomy allows fully correct all phenotype HCM, safe effective procedure definitive method this pathology minimizing disease recurrence.