Published Online
on September 29, 2003

A more recent version of this article appeared on October 28, 2003

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Submitted on August 13, 2002
Revised on July 24, 2003
Accepted on July 26, 2003

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

Chris van der Lee MD, Marcel J.M. Kofflard MD, Lex A. van Herwerden MD, Willem B. Vletter MSc, and Folkert J. ten Cate MD^*

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.

^* To whom correspondence should be addressed. E-mail: f.j.tencate{at}erasmusmc.nl.

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

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