Objective
Determine whether the intraoperative three-dimensional left ventricular outflow tract
cross-sectional area may be inversely correlated with pressure gradients as a determinant
of surgical success after septal myectomy in hypertrophic cardiomyopathy patients.
Design
Perioperative data were obtained by retrospective review.
Setting
Toronto General Hospital, University of Toronto, Toronto, Canada, a tertiary hospital.
Participants
The study comprised 67 patients with hypertrophic obstructive cardiomyopathy.
Interventions
Transthoracic and intraoperative transesophageal echocardiographic assessment of pressure
gradients. Transesophageal measurement of the three-dimensional left ventricular outflow
tract cross-sectional area.
Measurements and Main Results
The smallest left ventricular outflow tract area increased on average 1.883 cm2 (98.3%) after septal myectomy. There was a significant correlation between the increase
in the area and the transesophageal pressure gradients (r = –0.32; p = 0.01) after myectomy, but none with postoperative transthoracic gradients
at rest (r = –0.10; p = 0.42). Postoperative transesophageal and transthoracic gradients were
significantly correlated (r = 0.26; p = 0.04). The best risk factors to predict high residual gradients were
preoperative transesophageal gradient >97 mmHg, postoperative transesophageal area
<3.16 cm2, and moderate or more residual transesophageal mitral regurgitation (specificity
89%, 81%, and 78%, respectively).
Conclusions
Three-dimensional left ventricular outflow tract area measurements with transesophageal
echocardiography after myectomy correlated fairly well with postoperative transesophageal
pressure gradients. Patients with residual transthoracic elevated gradients after
surgery at follow-up had a smaller transesophageal area and higher transesophageal
pressure gradients immediately after the procedure. However, transesophageal pressure
gradients after myectomy correlated poorly with follow-up transthoracic gradients
at rest.
Key Words
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Article info
Publication history
Published online: December 11, 2020
Footnotes
This work was performed in the framework of the doctorate in surgery and morphologic sciences (RD 99/2011) of the Autonomous University of Barcelona
Identification
Copyright
© 2020 Published by Elsevier Inc.
