Abstract 3384: Resect-Plicate-Release Operation for Obstructive Hypertrophic Cardiomyopathy: Echocardiographic Results
Background: Surgical septal myectomy is the gold standard for management of refractory obstructive hypertrophic cardiomyopathy (HCM). However, this procedure is considered among the most difficult for acquired disease, and prone to complications and incomplete, inadequate results except in selected centers with extensive experience. In part, this may be because of the contribution of long anterior mitral leaflets and papillary muscle anomalies which are not addressed in the traditional myectomy. We report on the echocardiographic (echo) results of the Resect-Plicate-Release (RPR) operation for obstruction, which includes mitral anterior leaflet plication and papillary muscle release.
Methods: 35 patients with obstructive HCM undergoing surgery had echo before and 375±377 days after RPR repair. Plication and release were performed as indicated by the surgical anatomy.
Results: There were no in-hospital deaths. All patients had myectomy. 23 (66%) had anterior leaflet plication; 30 (86%) had papillary muscle release; 19 (54%) had both.
Conclusion: Plication results in a shortening of the anterior mitral valve leaflet which decreases leaflet slack and area. The thickening from the suture line also stiffens the anterior leaflet. These effects combine to markedly reduce or eliminate systolic anterior motion of the mitral valve. Papillary muscle release allows the mitral apparatus to drop posteriorly in the LV cavity. These adjuncts to myectomy result in more complete separation of the inflow and outflow portions of the left ventricle and abolition of SAM and gradient. Though the decision to add these procedures is made on the surgical anatomy, plication is done in patients with echocardiographic longer anterior leaflets, and papillary muscle release is done in patients with smaller septal to mitral coaptation distance.