Surgical treatment of hypertrophic obstructive cardiomyopathy in the elderly KALMAN

Introduction Successful cardiac surgery in the elderly is a practical proposition nowadays. The commonest indication for this is fixed obstruction to left ventricular ejection due to aortic valve disease (de Bono, English and Milstein, 1978; Hochberg et al., 1977). Left ventricular outflow obstruction can also occur owing to hypertrophic obstructive cardiomyopathy. Surgery can relieve this obstruction and operation may be indicated if the subvalvar gradient within the left ventricle is greater than 50 mmHg at rest (Goodwin, 1979; Wynne and Braunwald, 1980). However, the role of surgery in the management of this condition is controversial. Mason et al. (1978) in the United States have advocated it enthusiastically while McKenna et al. (1979) in the United Kingdom have suggested that surgery is one of the factors associated with a poor prognosis. Hypertrophic cardiomyopathy is being more commonly recognized in the elderly both in life (Krasnow and Stein, 1978; Berger, Rethy and Goldberg, 1979) and at post-mortem (Pomerance and Davies, 1975). Koch et al. (1980) in the United States have recently reviewed their experience with surgical treatment of this condition in the elderly. They concluded that surgery is as valuable in the management of older patients with this condition as it is in younger patients (Mason et al., 1978). The successful surgical treatment of this condition in 3 elderly patients in the United Kingdom is now reported and the role of surgery in the management of older patients as compared to younger patients is discussed.