ABSTRACT
<b>[Background] </b>Surgical septal myectomy is the gold-standard therapy for hypertrophic obstructive cardiomyopathy (HOCM) in Europe and America. However, few cases underwent surgical septal myectomy in Japan. We have performed the surgical transaortic extended left ventricular myectomy (LV myectomy) as a first choice in HOCM patients unresponsive to pharmacologic therapy. We report the short and medium term clinical outcomes. <b>Methods</b> : From May 2012 to September 2014, 9 patients underwent extended LV myectomy without other accompanying procedures. All cases were symptomatic and peak left ventricular outflow tract pressure gradients (LVOTG) were 50 mmHg or more. We assessed clinical and echocardiographic outcomes at the short and medium term, intra-operative findings and cardiomyocyte pathological findings. <b>Results</b> : All patients (mean age 64.3 years, 56% female) underwent transaortic LV myectomy with no obvious complications. Postoperative LVOTG were controlled within 10 mmHg or less. SAM disappeared completely in all patients and MR decreased to mild or less. LVOTG sustained good control of 10 mmHg or less under low-dose dobutamine stress echocardiography at the medium term. <b>Conclusion</b> : Our transaortic extended LV myectomy procedure is effective in decreasing LVOTG, SAM and MR with low operative morbidity and mortality.
ABSTRACT
A 66-year-old woman suffered from an effort angina attack and visited our clinic. Coronary angiography revealed severe stenosis in the ostium of bilateral coronary arteries. Preoperative computed tomography (CT) demonstrated severe calcification of the aorta and aneurysmal change in the thoracic descending aorta. Off-pump CABG was performed without mechanical cardiac support using composite grafts of the right internal mammary artery and a saphenous vein graft. Graft patency was intraoperatively confirmed by SPY as well as by coronary multi detector-row computed tomography (MDCT) 3 months postoperatively.