Circulation, Vol 79, 766-775, Copyright © 1989 by American Heart Association
RO Cannon 3d, CL McIntosh, WH Schenke, BJ Maron, RO Bonow and SE Epstein
To assess the impact of operative reduction of left ventricular outflow
obstruction in hypertrophic cardiomyopathy, measurements of great cardiac
vein flow, oxygen and lactate content, left ventricular pressures, and
cardiac index were measured at rest and during pacing stress in 20
consecutive patients (13, myotomy-myectomy; six, mitral valve replacement;
one, both myotomy-myectomy and mitral valve replacement) who underwent both
preoperative and postoperative studies. All had angiographically normal
epicardial coronary arteries. Operation resulted in reduction in outflow
gradient (64 +/- 38 to 4 +/- 7 mm Hg, p less than 0.001) and in left
ventricular systolic pressure (186 +/- 32 to 128 +/- 22 mm Hg, p less than
0.001) and was associated with reduction in great cardiac vein flow (101
+/- 26 to 78 +/- 16 ml/min, p less than 0.001) and oxygen consumption in
the anterior left ventricle and septum (11.9 +/- 4.1 to 8.4 +/- 1.9 ml
O2/min, p less than 0.001) in the basal state. During rapid atrial pacing,
13 of 20 patients experienced chest pain postoperatively, whereas all 20
developed chest pain during preoperative pacing, with an improvement in
pacing anginal threshold (or heart rate 150 if no chest pain was
experienced) of 16 +/- 18 beats/min (p less than 0.001). The peak great
cardiac vein flow (161 +/- 41 to 131 +/- 45 ml/min, p less than 0.025) and
myocardial oxygen consumption (19.4 +/- 6.1 to 14.3 +/- 5.5 ml O2/min, p
less than 0.005) during pacing, which correlated directly with the severity
of the basal left ventricular gradient (p = 0.011 and p = 0.002,
respectively), were also reduced by surgery. Lactate metabolism during
pacing changed from net production before surgery to net consumption after
operation (-17 +/- 47.6 to 4.4 +/- 29.8 mumol/min, p less than 0.01), with
six of 20 patients producing lactate after surgery compared with 13 of 20
before surgery (p = 0.06). The six patients with the highest peak great
cardiac vein flow (greater than 175 ml/min) during preoperative pacing had
greater symptom and metabolic benefit during pacing after surgery compared
with the 14 patients with lower peak coronary flow. Postpacing left
ventricular end-diastolic pressure (30 +/- 7 to 23 +/- 7 mm Hg, p less than
0.001) and pulmonary artery wedge pressure (24 +/- 6 to 20 +/- 5, p less
than 0.001) were reduced after surgery.(ABSTRACT TRUNCATED AT 400 WORDS)
ARTICLES
Effect of surgical reduction of left ventricular outflow obstruction on hemodynamics, coronary flow, and myocardial metabolism in hypertrophic cardiomyopathy
Cardiology Branche, National Heart, Lung, and Blood Institute, Bethesda, MD 20892.
This article has been cited by other articles:
 |
|
 |
|
  M. S. Maron, I. Olivotto, B. J. Maron, S. K. Prasad, F. Cecchi, J. E. Udelson, and P. G. Camici The case for myocardial ischemia in hypertrophic cardiomyopathy. J. Am. Coll. Cardiol., August 25, 2009; 54(9): 866 - 875. [Abstract] [Full Text] [PDF]
|
|
|
|
|
|
B. J. Maron, M. S. Maron, E. D. Wigle, and E. Braunwald The 50-year history, controversy, and clinical implications of left ventricular outflow tract obstruction in hypertrophic cardiomyopathy from idiopathic hypertrophic subaortic stenosis to hypertrophic cardiomyopathy: from idiopathic hypertrophic subaortic stenosis to hypertrophic cardiomyopathy. J. Am. Coll. Cardiol., July 14, 2009; 54(3): 191 - 200. [Abstract] [Full Text] [PDF]
|
|
|
|
 |
|
 P. Knaapen, T. Germans, P. G. Camici, O. E. Rimoldi, F. J. ten Cate, J. M. ten Berg, P. A. Dijkmans, R. Boellaard, W. G. van Dockum, M. J. W. Gotte, et al. Determinants of coronary microvascular dysfunction in symptomatic hypertrophic cardiomyopathy Am J Physiol Heart Circ Physiol, February 1, 2008; 294(2): H986 - H993. [Abstract] [Full Text] [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]
|
|
|
|
|
|
M. V. Sherrid, I. Barac, W. J. McKenna, P. M. Elliott, S. Dickie, L. Chojnowska, S. Casey, and B. J. Maron Multicenter study of the efficacy and safety of disopyramide in obstructive hypertrophic cardiomyopathy J. Am. Coll. Cardiol., April 19, 2005; 45(8): 1251 - 1258. [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]
|
|
|
|
|
|
B. J. Maron, W. J. McKenna, G. K. Danielson, L. J. Kappenberger, H. J. Kuhn, C. E. Seidman, P. M. Shah, W. H. Spencer III, P. Spirito, F. J. Ten Cate, et al. American College of Cardiology/European Society of Cardiology Clinical Expert Consensus Document on Hypertrophic Cardiomyopathy: a report of the American College of Cardiology Foundation Task Force on Clinical Expert Consensus Documents and the European Society of Cardiology Committee for Practice Guidelines J. Am. Coll. Cardiol., November 5, 2003; 42(9): 1687 - 1713. [Full Text] [PDF]
|
|
|
|
 |
|
 Writing Committee Members, B. J. Maron, W. J. McKenna, G. K. Danielson, L. J. Kappenberger, H. J. Kuhn, C. E. Seidman, P. M. Shah, W. H. Spencer III, P. Spirito, et al. American College of Cardiology/European Society of Cardiology Clinical Expert Consensus Document on Hypertrophic Cardiomyopathy: A report of the American College of Cardiology Foundation Task Force on Clinical Expert Consensus Documents and the European Society of Cardiology Committee for Practice Guidelines Eur. Heart J., November 1, 2003; 24(21): 1965 - 1991. [Full Text] [PDF]
|
|
|
|
 |
|
 W. Shamim, M. Yousufuddin, D. Wang, M. Henein, H. Seggewiss, M. Flather, A. J.S. Coats, and U. Sigwart Nonsurgical Reduction of the Interventricular Septum in Patients with Hypertrophic Cardiomyopathy N. Engl. J. Med., October 24, 2002; 347(17): 1326 - 1333. [Abstract] [Full Text] [PDF]
|
|
|
|
 |
|
 B. J. Maron Hypertrophic Cardiomyopathy: A Systematic Review JAMA, March 13, 2002; 287(10): 1308 - 1320. [Abstract] [Full Text] [PDF]
|
|
|
|
|
|
S. R. Ommen, R. A. Nishimura, R. W. Squires, H. V. Schaff, G. K. Danielson, and A. J. Tajik Comparison of dual-chamber pacing versus septal myectomy for the treatment of patients with hypertrophic obstructive cardiomyopathy: A comparison of objective hemodynamic and exercise end points J. Am. Coll. Cardiol., July 1, 1999; 34(1): 191 - 196. [Abstract] [Full Text] [PDF]
|
|
|
|
|
|
P. Spirito, C. E. Seidman, W. J. McKenna, and B. J. Maron The Management of Hypertrophic Cardiomyopathy N. Engl. J. Med., March 13, 1997; 336(11): 775 - 785. [Full Text] [PDF]
|
|
|
|
 |
|
 B. Heric, B. W. Lytle, D. P. Miller, E. R. Rosenkranz, H. M. Lever, and D. M. Cosgrove Surgical management of hypertrophic obstructive cardiomyopathy:Early and late results J. Thorac. Cardiovasc. Surg., July 1, 1995; 110(1): 195 - 208. [Abstract] [Full Text]
|
|
|
|
 |
|
 SURGERY BENEFITS SOME PATIENTS WITH HYPERTROPHIC CARDIOMYOPATHY Journal Watch (General), April 21, 1989; 1989(421): 5 - 5. [Full Text]
|
|