7. Septal myectomy for hypertrophic obstructive cardiomyopathy in the young adults and children

Abstract

Purpose Hypertrophic obstructive cardiomyopathy (HOCM) is one of the leading causes for heart failure in the young; few studies were published the results of surgical therapy in this age category. Our aim was to assess the late results of basal septal myectomy in the young. Methods We retrospectively reviewed the records of 128 consecutive patients (38% female), age less than 21 years, who underwent basal septal myectomy for HOCM in the period between 1975 and 2010 at the Mayo Clinic Foundation. Mean age at surgery was 13.6 ± 1.0 year and half of patients were in advanced heart failure (NYHA class III or IV). Average peak pressure gradient (APPG) across the left ventricular outflow tract was 89 mmHg and 95% had significant mitral regurgitation (MR) due to systolic anterior motion. Results Extended basal septal myectomy was performed in all patients. (APPG) decreased from 89 to 17 mmHg. Severe MR was detected in (1%). Five patients (3%) died during the late mean follow-up of 5 year. 2 were due to sudden death. The overall survival was 100%, 98%, and 86% at 1, 5, and 15 year, respectively. None of the patients needed intervention for the aortic valve, but 6 patients needed repeat septal myectomy; this was a significant risk factor for late death. At late follow up, 95% were in NYHA class I or II. Conclusion Basal septal myectomy is an effective and safe in children with HOCM, the narrow field and small size aortic root may increase risk of aortic or mitral valve injury.