Three-dimensional echocardiographic measurement to guide the dredging of left ventricular outflow tract in the treatment of hypertrophic obstructive cardiomyopathy with long-term follow-up_Chinese Journal of Clinical Thoracic and Cardiovascular Surgery

Authors：

SONG Yuankai ^1,2 , LIN Hong ³ , JIAN Yupeng ^1,2 , ZHOU Li ^1,2 , WANG Zhiping ^1,2 ,  OU Jingsong ^1,2

1. Division of Cardiac Surgery, Cardiovascular Research Institute, The First Affiliated Hospital, Sun Yat-sen University, Guangzhou, 510080, P. R. China;
2. National-Guangdong Joint Engineering Laboratory for Diagnosis and Treatment of Vascular Diseases, NHC Key Laboratory of Assisted Circulation (Sun Yat-sen University), Guangdong Provincial Engineering and Technology Center for Diagnosis and Treatment of Vascular Diseases, Guangzhou, 510080, P. R. China;
3. Department of Ultrasound, The First Affiliated Hospital, Sun Yat-sen University, Guangzhou, 510080, P. R. China;

Corresponding author：

OU Jingsong, Email: oujs@mail.sysu.edu.cn

Keywords：

Hypertrophic obstructive cardiomyopathy; surgery; echocardiography

DOI：

10.7507/1007-4848.202303079

Video：

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Objective To introduce a method of preoperative three-dimensional measurement by echocardiography to guide the surgical resection of hypertrophic obstructive cardiomyopathy (HOCM) and its long-term follow-up effect. Methods Before operation, each patient underwent transthoracic echocardiography to measure the length, width and thickness of diastolic ventricular septum hypertrophy on the long axis, short axis and four chamber sections, in order to establish three-dimensional measurement data of myocardial hypertrophy, and quantitatively estimate the location, depth and range of myocardium to be removed between 2014 and 2022 in our hospital. According to the quantitative data during operation, the hypertrophic myocardium of ventricular septum was resected to dredge the left ventricular outflow tract. Results Forty-three patients were recruited, including 22 males and 21 females, aged 18-78 (49.2±5.1) years. Eighteen patietns underwent mitral valve surgery at the same time. All patients were satisfied with the relief of left ventricular outflow tract obstruction. Postoperative transesophageal echocardiography showed that the left ventricular outflow tract pressure gradient decreased significantly (94.2±28.1 mm Hg vs. 6.7±4.7 mm Hg, P<0.05). There was no ventricular septal perforation or complete atrioventricular block during the operation, and no one needed a secondary aorta-clamp for re-operation to remove hypertrophic myocardium again. Postoperative echocardiography showed that the mitral valve closed well or only had mild regurgitation, and the mitral systolic anterior motion sign basically disappeared. After 1.0-8.5 years of follow-up, the average pressure difference of left ventricular outflow tract remained below 10 mm Hg, and the clinical symptoms disappeared or improved significantly. Conclusion The quantitative prediction of the resection range of hypertrophic myocardium by three-dimensional measurement of preoperative echocardiography can accurately guide the surgical range of HOCM, avoid multiple blocking of aorta during operation, relieve left ventricular outflow tract obstruction to the greatest extent, and obtain better long-term results.

Citation： SONG Yuankai, LIN Hong, JIAN Yupeng, ZHOU Li, WANG Zhiping, OU Jingsong. Three-dimensional echocardiographic measurement to guide the dredging of left ventricular outflow tract in the treatment of hypertrophic obstructive cardiomyopathy with long-term follow-up. Chinese Journal of Clinical Thoracic and Cardiovascular Surgery, 2023, 30(11): 1580-1585. doi: 10.7507/1007-4848.202303079 Copy

1.	国家心血管病中心心肌病专科联盟、中国医疗保健国际交流促进会心血管病精准医学分会“中国成人肥厚型心肌病诊断与治疗指南2023”专家组. 中国成人肥厚型心肌病诊断与治疗指南2023. 中国循环杂志, 2023, 38(1): 1-33.
2.	宋雷, 邹玉宝, 汪道文, 等. 中国成人肥厚型心肌病诊断与治疗指南. 中华心血管病杂志, 2017, 45(12): 1015-1032.
3.	Elliott PM, Anastasakis A, Borger MA, et al. 2014 ESC guidelines on diagnosis and management of hypertrophic cardiomyopathy: The Task Force for the Diagnosis and Management of Hypertrophic Cardiomyopathy of the European Society of Cardiology (ESC). Eur Heart J, 2014, 35(39): 2733-2779.
4.	Gersh BJ, Maron BJ, Bonow RO, et al. 2011 ACCF/AHA guideline for the diagnosis and treatment of hypertrophic cardiomyopathy: Executive summary: A report of the American College of Cardiology Foundation/American Heart Association Task Force on Practice Guidelines. Circulation, 2011, 124(24): 2761-2796.
5.	Ommen SR, Mital S, Burke MA, et al. 2020 AHA/ACC guideline for the diagnosis and treatment of patients with hypertrophic cardiomyopathy: A report of the American College of Cardiology/American Heart Association Joint Committee on Clinical Practice Guidelines. Circulation, 2020, 142(25): e558-e631.
6.	李馨, 汤楚中, 李寒. 经食管超声心动图标准化测量在改良Morrow术中的应用研究. 海军医学杂志, 2015, 36(6): 538-540.
7.	张燕搏, 常硕, 王水云, 等. 改良扩大Morrow手术治疗肥厚型梗阻性心肌病术后合并症及预后分析. 中国循环杂志, 2015, 30(6): 520-524.
8.	Solomon Z, Breton C, Rowin EJ, et al. Surgical approaches to hypertrophic obstructive cardiomyopathy. Semin Thorac Cardiovasc Surg, 2018, 30(2): 125-128.
9.	Nguyen A, Schaff HV. Surgical myectomy: Subaortic, midventricular, and apical. Cardiol Clin, 2019, 37(1): 95-104.
10.	Borisov KV. Surgery of hypertrophic obstructive cardiomyopathy in patients with severe hypertrophy, myocardial fibrosis, and ventricular tachycardia. Ann Thorac Surg, 2018, 106(1): 30-3s7.
11.	Kotkar KD, Said SM, Dearani JA, et al. Hypertrophic obstructive cardiomyopathy: The Mayo Clinic experience. Ann Cardiothorac Surg, 2017, 6(4): 329-336.
12.	郭鸿昌, 王生伟, 马赫赫, 等. 不同术式治疗肥厚型梗阻性心肌病效果的研究. 心肺血管病杂志, 2020, 39(6): 703-705, 710.
13.	罗明尧, 王水云, 宋云虎, 等. 118例肥厚型梗阻性心肌病的外科治疗经验. 中华医学杂志, 2013, 93(2): 110-113.
14.	简宇鹏, 孙培吾, 区景松. 肥厚型心肌病诊治进展. 心血管外科杂志(电子版), 2016, 5(1): 31-36.
15.	Fukuhara S, Edwards S, Kurlansky P, et al. Bimanual examination for septal myectomy for hypertrophic cardiomyopathy. Interact Cardiovasc Thorac Surg, 2014, 19(5): 735-737.
16.	Chou NK, Okano R, Tedoriya T, et al. Robotic transmitral approach for hypertrophic cardiomyopathy with systolic anterior motion. Circ J, 2018, 82(11): 2761-2766.
17.	Tang Y, Zhu W, Liu J, et al. Thoracoscopic transmitral myectomy for an anatomically complex case with midventricular obstruction. Ann Thorac Surg, 2021, 112(4) : e283-e286.
18.	Vanstraelen S, Vandenbrande J, Yilmaz A. Video-assisted thoracoscopic transaortic myectomy for hypertrophic obstructive cardiomyopathy. Ann Thorac Surg, 2021, 111(3): e217-e218.
19.	唐亚捷, 刘健, 陈钊, 等. 胸腔镜下经二尖瓣入路心肌切除术治疗肥厚型梗阻性心肌病的早期效果. 中华胸心血管外科杂志, 2020, 36(8): 472-477.
20.	Hermsen JL, Burke TM, Seslar SP, et al. Scan, plan, print, practice, perform: Development and use of a patient-specific 3-dimensional printed model in adult cardiac surgery. J Thorac Cardiovasc Surg, 2017, 153(1): 132-1340.
21.	Ma Y, Ding P, Li L, et al. Three-dimensional printing for heart diseases: Clinical application review. Biodes Manuf, 2021: 1-13.
22.	Yang DH, Kang JW, Kim N, et al. Myocardial 3-dimensional printing for septal myectomy guidance in a patient with obstructive hypertrophic cardiomyopathy. Circulation, 2015, 132(4): 300-301.
23.	Hamatani Y, Amaki M, Kanzaki H, et al. Contrast-enhanced computed tomography with myocardial three-dimensional printing can guide treatment in symptomatic hypertrophic obstructive cardiomyopathy. ESC Heart Fail, 2017, 4(4): 665-669.
24.	Hermsen JL, Yang R, Burke TM, et al. Development of a 3-D printing-based cardiac surgical simulation curriculum to teach septal myectomy. J Thorac Cardiovasc Surg, 2018, 156(3): e1139-e1148.

1. 国家心血管病中心心肌病专科联盟、中国医疗保健国际交流促进会心血管病精准医学分会“中国成人肥厚型心肌病诊断与治疗指南2023”专家组. 中国成人肥厚型心肌病诊断与治疗指南2023. 中国循环杂志, 2023, 38(1): 1-33.
2. 宋雷, 邹玉宝, 汪道文, 等. 中国成人肥厚型心肌病诊断与治疗指南. 中华心血管病杂志, 2017, 45(12): 1015-1032.
3. Elliott PM, Anastasakis A, Borger MA, et al. 2014 ESC guidelines on diagnosis and management of hypertrophic cardiomyopathy: The Task Force for the Diagnosis and Management of Hypertrophic Cardiomyopathy of the European Society of Cardiology (ESC). Eur Heart J, 2014, 35(39): 2733-2779.
4. Gersh BJ, Maron BJ, Bonow RO, et al. 2011 ACCF/AHA guideline for the diagnosis and treatment of hypertrophic cardiomyopathy: Executive summary: A report of the American College of Cardiology Foundation/American Heart Association Task Force on Practice Guidelines. Circulation, 2011, 124(24): 2761-2796.
5. Ommen SR, Mital S, Burke MA, et al. 2020 AHA/ACC guideline for the diagnosis and treatment of patients with hypertrophic cardiomyopathy: A report of the American College of Cardiology/American Heart Association Joint Committee on Clinical Practice Guidelines. Circulation, 2020, 142(25): e558-e631.
6. 李馨, 汤楚中, 李寒. 经食管超声心动图标准化测量在改良Morrow术中的应用研究. 海军医学杂志, 2015, 36(6): 538-540.
7. 张燕搏, 常硕, 王水云, 等. 改良扩大Morrow手术治疗肥厚型梗阻性心肌病术后合并症及预后分析. 中国循环杂志, 2015, 30(6): 520-524.
8. Solomon Z, Breton C, Rowin EJ, et al. Surgical approaches to hypertrophic obstructive cardiomyopathy. Semin Thorac Cardiovasc Surg, 2018, 30(2): 125-128.
9. Nguyen A, Schaff HV. Surgical myectomy: Subaortic, midventricular, and apical. Cardiol Clin, 2019, 37(1): 95-104.
10. Borisov KV. Surgery of hypertrophic obstructive cardiomyopathy in patients with severe hypertrophy, myocardial fibrosis, and ventricular tachycardia. Ann Thorac Surg, 2018, 106(1): 30-3s7.
11. Kotkar KD, Said SM, Dearani JA, et al. Hypertrophic obstructive cardiomyopathy: The Mayo Clinic experience. Ann Cardiothorac Surg, 2017, 6(4): 329-336.
12. 郭鸿昌, 王生伟, 马赫赫, 等. 不同术式治疗肥厚型梗阻性心肌病效果的研究. 心肺血管病杂志, 2020, 39(6): 703-705, 710.
13. 罗明尧, 王水云, 宋云虎, 等. 118例肥厚型梗阻性心肌病的外科治疗经验. 中华医学杂志, 2013, 93(2): 110-113.
14. 简宇鹏, 孙培吾, 区景松. 肥厚型心肌病诊治进展. 心血管外科杂志(电子版), 2016, 5(1): 31-36.
15. Fukuhara S, Edwards S, Kurlansky P, et al. Bimanual examination for septal myectomy for hypertrophic cardiomyopathy. Interact Cardiovasc Thorac Surg, 2014, 19(5): 735-737.
16. Chou NK, Okano R, Tedoriya T, et al. Robotic transmitral approach for hypertrophic cardiomyopathy with systolic anterior motion. Circ J, 2018, 82(11): 2761-2766.
17. Tang Y, Zhu W, Liu J, et al. Thoracoscopic transmitral myectomy for an anatomically complex case with midventricular obstruction. Ann Thorac Surg, 2021, 112(4) : e283-e286.
18. Vanstraelen S, Vandenbrande J, Yilmaz A. Video-assisted thoracoscopic transaortic myectomy for hypertrophic obstructive cardiomyopathy. Ann Thorac Surg, 2021, 111(3): e217-e218.
19. 唐亚捷, 刘健, 陈钊, 等. 胸腔镜下经二尖瓣入路心肌切除术治疗肥厚型梗阻性心肌病的早期效果. 中华胸心血管外科杂志, 2020, 36(8): 472-477.
20. Hermsen JL, Burke TM, Seslar SP, et al. Scan, plan, print, practice, perform: Development and use of a patient-specific 3-dimensional printed model in adult cardiac surgery. J Thorac Cardiovasc Surg, 2017, 153(1): 132-1340.
21. Ma Y, Ding P, Li L, et al. Three-dimensional printing for heart diseases: Clinical application review. Biodes Manuf, 2021: 1-13.
22. Yang DH, Kang JW, Kim N, et al. Myocardial 3-dimensional printing for septal myectomy guidance in a patient with obstructive hypertrophic cardiomyopathy. Circulation, 2015, 132(4): 300-301.
23. Hamatani Y, Amaki M, Kanzaki H, et al. Contrast-enhanced computed tomography with myocardial three-dimensional printing can guide treatment in symptomatic hypertrophic obstructive cardiomyopathy. ESC Heart Fail, 2017, 4(4): 665-669.
24. Hermsen JL, Yang R, Burke TM, et al. Development of a 3-D printing-based cardiac surgical simulation curriculum to teach septal myectomy. J Thorac Cardiovasc Surg, 2018, 156(3): e1139-e1148.

Chinese Journal of Clinical Thoracic and Cardiovascular Surgery

Three-dimensional echocardiographic measurement to guide the dredging of left ventricular outflow tract in the treatment of hypertrophic obstructive cardiomyopathy with long-term follow-up

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