Heart failure & cardiomyopathies
Impact of secondary mitral valve chordal cutting on valve geometry in obstructive hypertrophic cardiomyopathy with marked septal hypertrophy
Authors' conclusion
Resection of fibrotic secondary chordae moves the MV apparatus away from the outflow tract and enlarges the outflow area independently of septal thickness, facilitating septal myectomy by reducing the need for a deep muscular excision.
Study context
- Population
- Consecutive patients with obstructive hypertrophic cardiomyopathy (HCM) undergoing myectomy with resection of fibrotic anterior mitral leaflet (AML) secondary chordae124 normal subjects as comparison
- Participants
- 150 vs 62
- Exposure
- Secondary chordal resection in important vs mild septal thickness
- Important septal thicknessn = 150
- Mild septal thicknessn = 62reference
- Outcome
- MV position in the ventricular cavity (echocardiographic AML-annulus ratio), before vs after chordal resection
Methodological detailsconsecutive patients, before-after comparison
- Consecutive patients
- Before-after comparison
Main finding
As reported in the abstract
AML-annulus ratio, preoperative to postoperative Important septal thickness 0.55 ± 0.06 · Mild septal thickness 0.55 ± 0.06
Preoperative Important septal thickness 0.43 ± 0.05 · Mild septal thickness 0.43 ± 0.06
Increase
P (pre vs post) Important septal thickness P < 0.001 · Mild septal thickness P < 0.001
Observational data: associations, not effects.
Further findings
Mitral valve (MV) position within normal range (vs 124 normal subjects)
- Within normal range preoperatively
- <4%
- Normalized postoperatively
- >50%
Original publication
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