Circulation, Vol 90, 1781-1785, Copyright © 1994 by American Heart Association
JM ten Berg, MJ Suttorp, PJ Knaepen, SM Ernst, FE Vermeulen and W Jaarsma
BACKGROUND: This study was performed to assess the initial results and
long-term follow-up of Morrow septal myectomy for patients with
hypertrophic obstructive cardiomyopathy (HOCM). METHODS AND RESULTS: We
studied 38 consecutive patients with HOCM (age, 13 to 74 years) who
underwent a Morrow septal myectomy between 1977 and 1992. There were no
perioperative deaths, and the postoperative course was uneventful for all
except 2 of the patients. One patient required implantation of a pacemaker
due to a complete heart block, and in 1 patient a small ventricular septal
defect was caused. Follow-up (mean, 6.8 years) was 100% complete. No
patient was reoperated for recurrent HOCM. All except 1 patient experienced
a major functional improvement with a decrease of the mean New York Heart
Association functional class from 3.0 before operation to 1.5 at follow-up
(P < .001). Symptoms persisting during follow-up were angina pectoris in
3 of 22 patients (14%), dyspnea in 6 of 30 patients (20%), dizzy spells in
2 of 12 patients (17%), and syncope in 2 of 10 patients (20%). During
follow-up no HOCM related death occurred. All patients were restudied by
Doppler echocardiography. The peak gradient in the left ventricular outflow
tract decreased from 72 +/- 30 mm Hg (range, 31 to 144 mm Hg) to 6 +/- 4 mm
Hg (range, 0 to 20; P < .001). A systolic anterior movement was seen in
8 patients (21%) compared with 32 patients (97%) before the operation (P
< .001). The left ventricular outflow tract diameter increased from 17
+/- 3 mm (range, 10 to 23 mm) to 22 +/- 3 mm (range, 15 to 33 mm; P <
.001), and the mean subaortic septal thickness decreased from 23 +/- 5 mm
(range, 15 to 35 mm) to 15 +/- 6 mm (range, 8 to 30 mm; P < .001).
CONCLUSIONS: Morrow septal myectomy for patients with HOCM is a safe
procedure with an excellent clinical and Doppler echocardiographic
long-term follow-up.
ARTICLES
Hypertrophic obstructive cardiomyopathy. Initial results and long-term follow-up after Morrow septal myectomy
Department of Cardiology, St Antonius Hospital, Nieuwegein, The Netherlands.
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