This Article Full Text Full Text (PDF) All Versions of this Article: 108/17/2088    most recent 01.CIR.0000092912.57140.14v1 Alert me when this article is cited Alert me if a correction is posted Citation Map Services Email this article to a friend Similar articles in this journal Similar articles in PubMed Alert me to new issues of the journal Download to citation manager Request Permissions Citing Articles Citing Articles via HighWire Citing Articles via Google Scholar Google Scholar Articles by van der Lee, C. Articles by ten Cate, F. J. Search for Related Content PubMed PubMed Citation Articles by van der Lee, C. Articles by ten Cate, F. J. Related Collections CV surgery: transplantation, ventricular assistance, cardiomyopathy

(Circulation. 2003;108:2088.)
© 2003 American Heart Association, Inc.

Clinical Investigation and Reports

Sustained Improvement After Combined Anterior Mitral Leaflet Extension and Myectomy in Hypertrophic Obstructive Cardiomyopathy

From the Thoraxcenter (C.v.d.L., L.A.v.H., W.B.V., F.J.t.C.), Erasmus Medical Center Rotterdam, Rotterdam, the Netherlands, and The Albert Schweitzer Hospital (M.J.M.K.), Department of Cardiology, Dordrecht, the Netherlands.

Correspondence to Dr Folkert J. ten Cate, Erasmus Medical Center, Thoraxcenter, Room Ba 302, Dr Molewaterplein 40, 3015 GD Rotterdam, the Netherlands. E-mail f.j.tencate{at}erasmusmc.nl

Received August 13, 2002; de novo received April 17, 2003; revision received July 24, 2003; accepted July 26, 2003.

Background— Mitral leaflet extension (MLE) combined with septal myectomy is a new surgical approach to treat hypertrophic obstructive cardiomyopathy (HOCM) and an enlarged mitral leaflet area. The study presents the long-term clinical results and outcome of this technique.

Methods and Results— MLE entails grafting a glutaraldehyde-preserved autologous pericardial patch onto the center portion of the anterior mitral valve leaflet. Twenty-nine patients with HOCM were studied. Mean follow-up (±SD) was 3.4±2.1 years (range 3 months to 7.7 years). The preoperative calculated mitral leaflet area was 16.7±3.4 cm². New York Heart Association functional class improved significantly from 2.8±0.4 to 1.3±0.4 (P<0.05), width of the interventricular septum decreased from 23±4 to 17±2 mm (P<0.05), left ventricular outflow tract gradient decreased from 100±20 to 17±14 mm Hg (P<0.01), severity of mitral regurgitation graded on a scale from 0 to 4+ decreased from 2.5±0.9 to 0.5±0.6 (P<0.01), and severity of the systolic anterior motion of the mitral valve graded on a scale from 0 to 3+ decreased from 2.9±0.3 to 0.5±0.7 (P<0.01) postoperatively. There were no deaths associated with surgery.

Conclusions— Long-term follow-up shows sustained improvement in functional status, reduction of outflow tract obstruction, and attenuation of mitral regurgitation and systolic anterior motion of the mitral valve. In this respect, the new technique widens the surgical applications in HOCM.

Key Words: cardiomyopathy • surgery • mitral valve

This article has been cited by other articles:

				R. K. Kaple, R. T. Murphy, L. M. DiPaola, P. L. Houghtaling, H. M. Lever, B. W. Lytle, E. H. Blackstone, and N. G. Smedira Mitral Valve Abnormalities in Hypertrophic Cardiomyopathy: Echocardiographic Features and Surgical Outcomes Ann. Thorac. Surg., May 1, 2008; 85(5): 1527 - 1535. [Abstract] [Full Text] [PDF]

				A. J. Mittnacht, M. Fanshawe, and S. Konstadt Anesthetic Considerations in the Patient With Valvular Heart Disease Undergoing Noncardiac Surgery Seminars in Cardiothoracic and Vascular Anesthesia, March 1, 2008; 12(1): 33 - 59. [Abstract] [PDF]

				Wenxia Chai, Y. M Hoedemaekers, R. H. van Schaik, M. van Fessem, I. M Garrelds, J. J Saris, D. Dooijes, F. J ten Cate, M. M. Kofflard, and A. J. Danser Cardiac aldosterone in subjects with hypertrophic cardiomyopathy Journal of Renin-Angiotensin-Aldosterone System, December 1, 2006; 7(4): 225 - 230. [Abstract] [PDF]

				S. R. Ommen, B. J. Maron, I. Olivotto, M. S. Maron, F. Cecchi, S. Betocchi, B. J. Gersh, M. J. Ackerman, R. B. McCully, J. A. Dearani, et al. Long-Term Effects of Surgical Septal Myectomy on Survival in Patients With Obstructive Hypertrophic Cardiomyopathy J. Am. Coll. Cardiol., August 2, 2005; 46(3): 470 - 476. [Abstract] [Full Text] [PDF]

				C. van der Lee, F. J. ten Cate, M. L. Geleijnse, M. J. Kofflard, C. Pedone, L. A. van Herwerden, E. Biagini, W. B. Vletter, and P. W. Serruys Percutaneous Versus Surgical Treatment for Patients With Hypertrophic Obstructive Cardiomyopathy and Enlarged Anterior Mitral Valve Leaflets Circulation, July 26, 2005; 112(4): 482 - 488. [Abstract] [Full Text] [PDF]

				B. J. Maron, J. A. Dearani, S. R. Ommen, M. S. Maron, H. V. Schaff, B. J. Gersh, and R. A. Nishimura The case for surgery in obstructive hypertrophic cardiomyopathy J. Am. Coll. Cardiol., November 16, 2004; 44(10): 2044 - 2053. [Abstract] [Full Text] [PDF]

				W. G. Williams, C. van der Lee, L. A. van Herwerden, W. B. Vletter, F. J. ten Cate, and M. J.M. Kofflard Combined Anterior Mitral Leaflet Extension and Myectomy in Hypertrophic Obstructive Cardiomyopathy * Response Circulation, June 29, 2004; 109(25): e324 - e324. [Full Text] [PDF]