Midterm postoperative follow-up after surgical correction of hypertrophic cardiomyopathy in infancy and childhood

Abstract

Background

Surgical septal myectomy has been considered the gold-standard therapeutic option for symptomatic drug refractory patients with hypertrophic obstructive cardiomyopathy (HOCM) for over 50 years. However, it is being challenged by less- invasive interventional tools in the last 2 decades. The late effects of myocardial scar from alcohol septal ablation are unknown and, therefore, are not recommended in children and young adults.

Methods

A total of 9 patients underwent surgical interventions for HOCM. All patients were below 12 years of age. The patients were operated upon in Cairo University Hospitals, Egypt; in the period between April 2014 and February 2016. Pre-operative and operative data were collected and analyzed statistically. Post-operative evaluation was documented at different periods and data collected and analyzed in comparison with pre-operative data as well as at these different follow up periods.

Results

Mean age of all patients was 6.1 ± 2.6 years. 77.8% were males. All the patients were symptomatic. Preoperative mean pressure gradient (PG) was 95.4 ± 15.2 mmHg. Mean septal wall thickness (SWT) was 1.52 + 0.45 cm, mean degree of mitral regurge (MR) was 1.7 ± 0.83. Immediate postoperative assessment showed significant clinical improvement and significant reduction of PG to 20.0 ± 14 mmHg, SWT to 0.98 ± 0.38 cm, and mean degree of MR to 0.89 ± 0.33. Short-term and mid-term follow up showed sustained improvement. There were no deaths.

Conclusions

Surgical procedures for HOCM are generally safe and effective for improvement of symptoms, LVOT gradient, mitral regurge. Early surgical intervention is advocated to prevent progression of valve disease.