Left ventricular remodeling following septal myectomy in hypertrophic obstructive cardiomyopathy

Tsuyoshi Yamabe; Jonathan Ginns; Vijay Vedula; Jay S Leb; Yuichi J Shimada; Shepard D Weiner; Hiroo Takayama

doi:10.1016/j.xjon.2022.05.018

Left ventricular remodeling following septal myectomy in hypertrophic obstructive cardiomyopathy

JTCVS Open. 2022 Jun 27:11:105-115. doi: 10.1016/j.xjon.2022.05.018. eCollection 2022 Sep.

Authors

Tsuyoshi Yamabe^{1

2}, Jonathan Ginns³, Vijay Vedula⁴, Jay S Leb⁵, Yuichi J Shimada⁶, Shepard D Weiner⁶, Hiroo Takayama¹

Affiliations

¹ Division of Cardiothoracic and Vascular Surgery, New York Presbyterian Hospital, Columbia University Medical Center, New York, NY.
² Department of Cardiovascular Surgery, Shonan-Kamakura General Hospital, Kamakura, Kanagawa, Japan.
³ Department of Cardiology, Heart Hospital of Austin, Tex.
⁴ Department of Mechanical Engineering, Columbia University, New York, NY.
⁵ Department of Radiology, New York Presbyterian Hospital, Columbia University Medical Center, New York, NY.
⁶ Department of Medicine Cardiology, New York Presbyterian Hospital, Columbia University Medical Center, New York, NY.

Abstract

Objectives: The purpose of this study is to determine whether or not left ventricular remodeling can be induced after septal myectomy in patients with obstructive hypertrophic cardiomyopathy, and if so, how it occurs, using gated cardiac computed tomography.

Methods: Fifty patients with hypertrophic obstructive cardiomyopathy who underwent septal myectomy along the septal band between March 2016 and July 2020 were retrospectively reviewed. Recent consecutive 19 patients underwent postoperative cardiac computed tomography. In these patients, volumes of the septal band and thickness of 17 left ventricular myocardial segments were measured to determine the changes after surgery.

Results: The resection volume predicted by preoperative computed tomography and the actual resection volume were 6.7 ± 3.3 mL and 6.4 ± 2.7 mL. In-hospital mortality was 0%. Moderate or greater mitral valve regurgitation and systolic anterior motion decreased from 56% to 6% and 86% to 6%, respectively. Median preoperative ventricular septal thickness and left ventricular outflow tract pressure gradient at rest decreased from 20.0 mm (interquartile range, 17.0-24.0 mm) and 74.0 mm Hg (interquartile range, 42.5-92.5 mm Hg) to 14.0 mm (interquartile range, 11.5-16.0 mm) and 15.5 mm Hg (interquartile range, 12.1-21.5 mm Hg), respectively. Postoperative computed tomography confirmed a reduction in septal band volume of 5.7 ± 2.8 mL. Total left ventricular myocardial volume was reduced by 12.9 ± 8.8 mL, which exceeded the volume reduction of the resected septal band. All segments except the basal inferior and basal inferolateral regions showed a significant decrease in wall thickness by a median of 6.4%.

Conclusions: Properly performed septal myectomy may induce remodeling of the entire left ventricle, not just the resected area.

Keywords: 3-dimensional computed tomography; 3D-CT, 3-dimensional computed tomography; AF, atrial fibrillation; CTA, computed tomography angiogram; ECG, electrocardiogram; HCM, hypertrophic cardiomyopathy; LV, left ventricle; LVOT, left ventricular outflow tract; NYHA, New York Heart Association; SAM, systolic anterior motion; SM, septal myectomy; TEE, transesophageal echocardiography; TTE, transthoracic echocardiography; VM, virtual myectomy; hypertrophic cardiomyopathy; left ventricular myocardium remodeling; left ventricular outflow tract obstruction; mitral regurgitation; septal myectomy; systolic anterior motion.