Epicardial Real-Time 3-Dimensional Echocardiography During Septal Myectomy for Obstructive Hypertrophic Cardiomyopathy
A 22-year-old man who had hypertrophic cardiomyopathy and progressive exertional dyspnea despite treatment with β-blockers was referred for septal myectomy. Preoperative transthoracic echocardiography showed severe asymmetric septal hypertrophy (septal thickness of 3.1 cm) with marked systolic anterior motion of the mitral valve and a dynamic left ventricular outflow tract (LVOT) gradient of 125 mm Hg. Epicardial real-time 3-dimensional echocardiography (RT3DE) (Sonos 7500, Philips Medical Systems), was performed intraoperatively, providing 3-dimensional visualization of the LVOT before and after septal myectomy (Figure 1; Data Supplement Video Clips). Preoperatively, epicardial RT3DE visualization of the LVOT enhanced the spatial assessment of the site, the extent of maximal septal thickness, and the extent of systolic mitral leaflet-to-septal contact—important information that helped the surgeon to optimize the site and size of the septal myectomy. A segment of septal myocardium measuring 4.5×2.5×1.5 cm was removed via a transaortic approach without complication (Figure 2). Postoperatively, transesophageal echocardiography confirmed a widely patent LVOT, with no residual gradient at baseline or after provocation with isoproterenol. Repeat epicardial RT3DE confirmed a widely patent LVOT throughout systole, with no residual obstruction. Epicardial RT3DE can help optimize the intraoperative spatial assessment of the location and extent of LVOT obstruction in patients with hypertrophic cardiomyopathy undergoing septal myectomy.
Video clips of the images shown in Figure 1 are available in the online-only Data Supplement at http://www.circulationaha.org.
The editor of Images in Cardiovascular Medicine is Hugh A. McAllister, Jr, MD, Chief, Department of Pathology, St Luke’s Episcopal Hospital and Texas Heart Institute, and Clinical Professor of Pathology, University of Texas Medical School and Baylor College of Medicine.
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