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National Academy of Medical Sciences of Ukraine State Institution "The National Research Center for Radiation Medicine"
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ISSN 2313-4607 (Online) ISSN 2304-8336 (Print) |
Problems of Radiation Medicine and Radiobiology |
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M. O. Tregubova1, Ê. Â. Rudenko1, V. V. Lazoryshynets1, S. V. Fedkiv1, O. M. Trembovetskaya1,
P. A. Danchenko2, Yu. I. Vitkovsky1, M. S. Ishchenko1, A. Yu. Gavrylyshyn1, V. V. Parfentyeva1,
Yu. Yu. Stukov3
1SI «Amosov National Institute of Cardiovascular Surgery of National Academy of Medical Sciences of
Ukraine», 6 Amosova St., Kyiv, 03038, Ukraine
2Bohomolets National Medical University, 13 Tarasa Shevchenka Blvd., Kyiv, 01601, Ukraine
3Center of Regenerative Medicine, Division of cardiovascular medicine, University of Florida, Gainesville,
FL 32611, United States
THE PLACE OF CARDIAC COMPUTED TOMOGRAPHY IN PREOPERATIVE PLANNING OF EXTENDED SEPTAL MYECTOMY IN PATIENTS WITH OBSTRUCTIVE FORM OF HYPERTROPHIC CARDIOMYOMATHY
Background. Hypertrophic cardiomyopathy (HCM) is the most common genetic cardiomyopathy. Extended septal
myectomy ( ESM) is one of the priority methods of treatment of drug-refractory obstructive HCM. In recent years,
hospital mortality during surgical correction of obstructive HCM in expert centers does not exceed 1–2 %. However,
typical threatening complications of septal myectomy, such as iatrogenic ventricular septal defect (VSD) and rupture of the anterior or posterior walls of the left ventricle (LV), remain a topical issue in surgery of HCM.
Objective: to show the role of preoperative CT-planning to predict and reduce possible technical problems associated with ESM, including iatrogenic VSD.
Methods and materials. This study includes 217 symptomatic patients with obstructive HCM, who from April 2016
to October 2019 as one of the steps of preoperative planning underwent cardiac CT prior to ESM. Cardiac CT was performed to delineate the left ventricular myocardium, assess the distribution of hypertrophy and the presence of
crypts. Special attention was also paid to the anatomy of the mitral valve (MV) and subvalvular apparatus. Coronary
artery patency was assessed by CAD-RADS, a standardized method for reporting the results of coronary CT angiography to determine tactics for further management of the patient.
Results and discussion. In the study group, the average age of patients was (49 ± 15) years, 48 % – men. All patients
had a symptomatic, drug-refractory obstructive form of HCM. The mean maximum wall thickness of the interventricular septum (IVS) was (20 ± 5) mm (range 16–33). The average LV mass was (118 ± 23) g/m2. 195 patients (89.9 %)
had systolic anterior motion ( SAM) of the MV. MV and subvalvular apparatus anomalies were detected in 62 patients
(28.6 %). A zone of scarring and regression of IVS after alcohol septal ablation (ASA) was detected in 7 patients
(0.3 %) with residual LV outflow gradient. Coronary arteries atherosclerosis was detected in 32 patients (14.7 %).
Conclusions. Preoperative CT-planning of septal myectomy allows to obtain information on morphology of the LV,
IVS, MV and subvalvular apparatus, and gives the surgeon the advantage to form a more accurate plan for the location and volume of septal resection, and avoid complications when correcting obstructive HCM. No iatrogenic VSD
was detected in any of the patient in the study group.
Key words: hypertrophic cardiomyopathy, computed tomography, preoperative planning, extended septal myectomy.
Problems of Radiation Medicine and Radiobiology. 2020;25:592-606. doi: 10.33145/2304-8336-2020-25-592-606
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1. Gersh BJ, Maron BJ, Bonow RO, Dearani JA, Fifer MA, Link MS, et al. 2011 ACCF/AHA guideline for the diagnosis and treatment of hypertrophic cardiomyopathy. Circulation. 2011;124(24):2761-2796. doi: 10.1161/CIR.0b013e318223e230.
2. Ommen SR, Maron BJ, Olivotto I, Maron MS, Cecchi F, Betocchi S, et al. Long-term effects of surgical septal myectomy on survival in patients with obstructive hypertrophic cardiomyopathy. J Am Coll Cardiol. 2005;46(3):470-476. doi: 10.1016/j.jacc.2005.02.090.
3. Smedira NG, Lytle BW, Lever HM, Rajeswaran J, Krishnaswamy G, Kaple RK, et al. Current effectiveness and risks of isolated septal myectomy for hypertrophic obstructive cardiomyopathy. Ann Thorac Surg. 2008;85(1):127-133. doi: 10.1016/j.athoracsur.2007.07.063.
4. Balaram SK, Ross RE, Sherrid MV, Schwartz GS, Hillel Z, Winson G, Swistel DG. Role of mitral valve plication in the management of hypertrophic cardiomyopathy. Ann Thorac Surg. 2012;94(6):1990-1997. doi: 10.1016/j.athoracsur.2012.06.008.
5. Iacovoni A, Spirito P, Simon C, Iascone M, Di Dedda G, De Filippo P, et al. A contemporary European experience with surgical septal myectomy in hypertrophic cardiomyopathy. Eur Heart J. 2012;33(16):2080-2087. doi: 10.1093/eurheartj/ehs064.
6. Desai MY, Bhonsale A, Smedira NG, Naji P, Thamilarasan M, Lytle BW, Lever HM. Predictors of long-term outcomes in symptomatic hypertrophic obstructive cardiomyopathy patients undergoing surgical relief of left ventricular outflow tract obstruction. Circulation. 2013;128(3):209-216. doi: 10.1161/CIRCULATIONAHA.112.000849.
7. Vriesendorp PA, Schinkel AF, Soliman OI, Kofflard MJ, de Jong PL, van Herwerden LA, et al. Long-term benefit of myectomy and anterior mitral leaflet extension in obstructive hypertro- phic cardiomyopathy. Am J Cardiol. 2015;115(5):670-675. doi: 10.1016/j.amjcard.2014.12.017.
8. Rastegar H, Boll G, Rowin EJ, Dolan N, Carroll C, Udelson JE, et al. Results of surgical septal myectomy for obstructive hypertrophic cardiomyopathy: the Tufts experience. Ann Cardiovasc Surg. 2017;6(4):353-363. doi: 10.21037/acs.2017.07.07.
9. Klues HG, Schiffers A, Maron BJ. Phenotypic spectrum and patterns of left ventricular hypertrophy in hypertrophic cardiomyopathy: Morphologic observations and significance as assessed by two-dimensional echocardiography in 600 patients. J Am Coll Cardiol. 1995;26(7):1699-1708. doi: 10.1016/0735-1097(95)00390-8.
10. Ferrazzi P, Spirito P, Iacovoni A, Calabrese A, Migliorati K, Simon C, et al. Transaortic chordal cutting: mitral valve repair for obstructive hypertrophic cardiomyopathy with mild septal hypertrophy. J Am Coll Cardiol. 2015;66(15):1687-1696. doi: 10.1016/j.jacc.2015.07.069.
11. Maron MS, Rowin EJ, Lin D, Appelbaum E, Chan RH, Gibson CM, et al. Prevalence and clinical profile of myocardial crypts in hypertrophic cardiomyopathy. Circ Cardiovasc Imaging. 2012;5(4):441-447. doi: 10.1161/CIRCIMAGING.112.972760.
12. Minakata K, Schaff HV, Zehr KJ, Dearani JA, Daly RC, Orszulak TA, et al. Extended septal myectomy for hypertrophic obstructive cardiomyopathy with anomalous mitral papillary muscles or chordae. J Thorac Cardiovasc Surg. 2004;127(2):481-489. doi: 10.1016/j.jtcvs.2003.09.040.
13. Messmer BJ. Extended myectomy for hypertrophic obstructive cardiomyopathy. Ann Thorac Surg. 1994;58(2):575-577. doi: 10.1016/0003-4975(94)92268-3.
14. Florian A, Masci PG, De Buck S, Aquaro GD, Claus P, Todiere G, et al. Geometric assessment of asymmetric septal hypertrophic cardiomyopathy by CMR. JACC: Cardiovasc Imaging. 2012;5(7):702-711. doi: 10.1016/j.jcmg.2012.03.011.
15. Maron MS, Maron BJ. Clinical impact of contemporary cardiovascular magnetic resonance imaging in hypertrophic cardiomyopathy. Circulation. 2015;132(4):292-298. doi: 10.1161/CIRCULATIONAHA.114.014283.
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