Surgery for Hypertrophic Obstructive Cardiomyopathy

Abstract

Hypertrophic obstructive cardiomyopathy (HOCM) is an inherited disorder with variable expressivity, resulting in asymmetric septal hypertrophy and left ventricular outflow tract obstruction (LVOTO). Symptoms are similar to those of aortic stenosis and are due to LV diastolic dysfunction and myocardial ischemia in the absence of epicardial coronary narrowing. Goals of treatment include symptomatic control, resolution of hemodynamic abnormalities and their sequelae, reduction of sudden cardiac death risk and screening of family members. Left ventricular outflow tract obstruction at rest is a predictor of severe symptoms, heart failure, and death. The majority of patients are managed medically, predominantly with b-blockers and calcium channel blockade.Disopyramide, a negative inotrope, can be used in cases with persistently high resting gradients. To prevent sudden cardiac death, implantable cardioverterdefibrillators are used aggressively.