PMID- 8759090
OWN - NLM
STAT- MEDLINE
DCOM- 19961211
LR  - 20190623
IS  - 0009-7322 (Print)
IS  - 0009-7322 (Linking)
VI  - 94
IP  - 3
DP  - 1996 Aug 1
TI  - Extent of clinical improvement after surgical treatment of hypertrophic 
      obstructive cardiomyopathy.
PG  - 467-71
AB  - BACKGROUND: A subgroup of patients with hypertrophic obstructive cardiomyopathy 
      remain severely symptomatic despite optimal medical therapy. Septal myectomy 
      reduces or eliminates left ventricular outflow obstruction and produces marked 
      symptomatic improvement. With the recent advent of alternative methods for 
      treatment of this disorder, such as dual-chamber pacing, it is necessary to 
      establish the risks and benefits of septal myectomy in the modern surgical era. 
      METHODS AND RESULTS: The clinical, ECG, echocardiographic, cardiac 
      catheterization, and surgical data were analyzed for 65 patients 20 to 70 years 
      old with hypertrophic obstructive cardiomyopathy who had surgical treatment 
      between 1986 and 1992. Specific symptoms and overall functional status were 
      evaluated before surgery and at the end of the first postoperative year. 
      Subsequent long-term clinical postoperative follow-up was also obtained. The 
      extent of postoperative improvement was measured by the presence and severity of 
      persistent symptoms, overall New York Heart Association (NYHA) functional class, 
      and patients' self-perceptions of overall improvement. Of the patients, 95% were 
      in NYHA functional class III or IV before surgery: 95% had dyspnea, 62% had 
      angina, 63% had near-syncope, and 23% had syncope. The overall early mortality 
      rate was 4.6%; there was no mortality among the 45 patients who underwent 
      isolated septal myectomy. At the 1-year postoperative evaluation, 89% of 
      survivors were in NYHA functional class I or II, and 47% believed that they had 
      100% improvement. Significant improvement (as defined) was seen in 67% of 
      patients with dyspnea, 90% with angina, 86% with near-syncope, and 100% with 
      syncope. The 5-year survival rate was 92%. CONCLUSIONS: The results of the 
      present study reaffirm the efficacy of surgical treatment of hypertrophic 
      obstructive cardiomyopathy in patients who are severely symptomatic despite 
      optimal medical therapy and serve as a useful reference by which the surgical 
      approach can be compared with new and potentially promising treatment 
      alternatives.
FAU - McCully, R B
AU  - McCully RB
AD  - Division of Cardiovascular Diseases, Mayo Clinic, Rochester, Minn 55905, USA.
FAU - Nishimura, R A
AU  - Nishimura RA
FAU - Tajik, A J
AU  - Tajik AJ
FAU - Schaff, H V
AU  - Schaff HV
FAU - Danielson, G K
AU  - Danielson GK
LA  - eng
PT  - Journal Article
PL  - United States
TA  - Circulation
JT  - Circulation
JID - 0147763
SB  - IM
MH  - Adult
MH  - Aged
MH  - Atrial Fibrillation/complications
MH  - Cardiac Catheterization
MH  - Cardiomyopathy, Hypertrophic/complications/physiopathology/*surgery
MH  - Echocardiography
MH  - Echocardiography, Doppler
MH  - Electrocardiography
MH  - Female
MH  - Humans
MH  - Male
MH  - Middle Aged
MH  - Postoperative Period
MH  - Survival Analysis
MH  - Treatment Outcome
EDAT- 1996/08/01 00:00
MHDA- 1996/08/01 00:01
CRDT- 1996/08/01 00:00
PHST- 1996/08/01 00:00 [pubmed]
PHST- 1996/08/01 00:01 [medline]
PHST- 1996/08/01 00:00 [entrez]
AID - 10.1161/01.cir.94.3.467 [doi]
PST - ppublish
SO  - Circulation. 1996 Aug 1;94(3):467-71. doi: 10.1161/01.cir.94.3.467.