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Association Between Three-Dimensional Left Ventricular Outflow Tract Area and Gradients After Myectomy in Hypertrophic Obstructive Cardiomyopathy
Determine whether the intraoperative three-dimensional left ventricular outflow tract cross-sectional area may be inversely correlated with pressure gradients as a determinant of surgical success after septal myectomy in hypertrophic cardiomyopathy patients. Perioperative data were obtained by retro...
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| Published in: | Journal of cardiothoracic and vascular anesthesia 2021-06, Vol.35 (6), p.1654-1662 |
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| container_title | Journal of cardiothoracic and vascular anesthesia |
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| creator | Moreno Garijo, J. Amador, Y. Fan, C.S. Silverton, N. Ralph-Edwards, A. Woo, A. Mashari, A. Meineri, M. |
| description | Determine whether the intraoperative three-dimensional left ventricular outflow tract cross-sectional area may be inversely correlated with pressure gradients as a determinant of surgical success after septal myectomy in hypertrophic cardiomyopathy patients.
Perioperative data were obtained by retrospective review.
Toronto General Hospital, University of Toronto, Toronto, Canada, a tertiary hospital.
The study comprised 67 patients with hypertrophic obstructive cardiomyopathy.
Transthoracic and intraoperative transesophageal echocardiographic assessment of pressure gradients. Transesophageal measurement of the three-dimensional left ventricular outflow tract cross-sectional area.
The smallest left ventricular outflow tract area increased on average 1.883 cm2 (98.3%) after septal myectomy. There was a significant correlation between the increase in the area and the transesophageal pressure gradients (r = –0.32; p = 0.01) after myectomy, but none with postoperative transthoracic gradients at rest (r = –0.10; p = 0.42). Postoperative transesophageal and transthoracic gradients were significantly correlated (r = 0.26; p = 0.04). The best risk factors to predict high residual gradients were preoperative transesophageal gradient >97 mmHg, postoperative transesophageal area |
| doi_str_mv | 10.1053/j.jvca.2020.12.014 |
| format | article |
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Perioperative data were obtained by retrospective review.
Toronto General Hospital, University of Toronto, Toronto, Canada, a tertiary hospital.
The study comprised 67 patients with hypertrophic obstructive cardiomyopathy.
Transthoracic and intraoperative transesophageal echocardiographic assessment of pressure gradients. Transesophageal measurement of the three-dimensional left ventricular outflow tract cross-sectional area.
The smallest left ventricular outflow tract area increased on average 1.883 cm2 (98.3%) after septal myectomy. There was a significant correlation between the increase in the area and the transesophageal pressure gradients (r = –0.32; p = 0.01) after myectomy, but none with postoperative transthoracic gradients at rest (r = –0.10; p = 0.42). Postoperative transesophageal and transthoracic gradients were significantly correlated (r = 0.26; p = 0.04). The best risk factors to predict high residual gradients were preoperative transesophageal gradient >97 mmHg, postoperative transesophageal area <3.16 cm2, and moderate or more residual transesophageal mitral regurgitation (specificity 89%, 81%, and 78%, respectively).
Three-dimensional left ventricular outflow tract area measurements with transesophageal echocardiography after myectomy correlated fairly well with postoperative transesophageal pressure gradients. Patients with residual transthoracic elevated gradients after surgery at follow-up had a smaller transesophageal area and higher transesophageal pressure gradients immediately after the procedure. However, transesophageal pressure gradients after myectomy correlated poorly with follow-up transthoracic gradients at rest.</description><identifier>ISSN: 1053-0770</identifier><identifier>EISSN: 1532-8422</identifier><identifier>DOI: 10.1053/j.jvca.2020.12.014</identifier><identifier>PMID: 33431273</identifier><language>eng</language><publisher>United States: Elsevier Inc</publisher><subject>Canada ; Cardiomyopathy, Hypertrophic - diagnostic imaging ; Cardiomyopathy, Hypertrophic - surgery ; Echocardiography, Transesophageal ; Humans ; hypertrophic cardiomyopathy ; intraoperative transesophageal echocardiography ; left ventricular hypertrophy ; left ventricular outflow obstruction ; Mitral Valve Insufficiency ; Retrospective Studies ; three-dimensional echocardiography ; Treatment Outcome ; Ventricular Outflow Obstruction - diagnostic imaging ; Ventricular Outflow Obstruction - surgery</subject><ispartof>Journal of cardiothoracic and vascular anesthesia, 2021-06, Vol.35 (6), p.1654-1662</ispartof><rights>2021</rights><rights>Copyright © 2021. Published by Elsevier Inc.</rights><lds50>peer_reviewed</lds50><woscitedreferencessubscribed>false</woscitedreferencessubscribed><citedby>FETCH-LOGICAL-c356t-80b3822013e405ae14cb4de61edc3fd078753773861c8ca89a2bb483e7adacdc3</citedby><cites>FETCH-LOGICAL-c356t-80b3822013e405ae14cb4de61edc3fd078753773861c8ca89a2bb483e7adacdc3</cites><orcidid>0000-0002-4217-5453 ; 0000-0002-1278-0118 ; 0000-0001-8054-4662 ; 0000-0002-8403-1271</orcidid></display><links><openurl>$$Topenurl_article</openurl><openurlfulltext>$$Topenurlfull_article</openurlfulltext><thumbnail>$$Tsyndetics_thumb_exl</thumbnail><link.rule.ids>314,776,780,27903,27904</link.rule.ids><backlink>$$Uhttps://www.ncbi.nlm.nih.gov/pubmed/33431273$$D View this record in MEDLINE/PubMed$$Hfree_for_read</backlink></links><search><creatorcontrib>Moreno Garijo, J.</creatorcontrib><creatorcontrib>Amador, Y.</creatorcontrib><creatorcontrib>Fan, C.S.</creatorcontrib><creatorcontrib>Silverton, N.</creatorcontrib><creatorcontrib>Ralph-Edwards, A.</creatorcontrib><creatorcontrib>Woo, A.</creatorcontrib><creatorcontrib>Mashari, A.</creatorcontrib><creatorcontrib>Meineri, M.</creatorcontrib><title>Association Between Three-Dimensional Left Ventricular Outflow Tract Area and Gradients After Myectomy in Hypertrophic Obstructive Cardiomyopathy</title><title>Journal of cardiothoracic and vascular anesthesia</title><addtitle>J Cardiothorac Vasc Anesth</addtitle><description>Determine whether the intraoperative three-dimensional left ventricular outflow tract cross-sectional area may be inversely correlated with pressure gradients as a determinant of surgical success after septal myectomy in hypertrophic cardiomyopathy patients.
Perioperative data were obtained by retrospective review.
Toronto General Hospital, University of Toronto, Toronto, Canada, a tertiary hospital.
The study comprised 67 patients with hypertrophic obstructive cardiomyopathy.
Transthoracic and intraoperative transesophageal echocardiographic assessment of pressure gradients. Transesophageal measurement of the three-dimensional left ventricular outflow tract cross-sectional area.
The smallest left ventricular outflow tract area increased on average 1.883 cm2 (98.3%) after septal myectomy. There was a significant correlation between the increase in the area and the transesophageal pressure gradients (r = –0.32; p = 0.01) after myectomy, but none with postoperative transthoracic gradients at rest (r = –0.10; p = 0.42). Postoperative transesophageal and transthoracic gradients were significantly correlated (r = 0.26; p = 0.04). The best risk factors to predict high residual gradients were preoperative transesophageal gradient >97 mmHg, postoperative transesophageal area <3.16 cm2, and moderate or more residual transesophageal mitral regurgitation (specificity 89%, 81%, and 78%, respectively).
Three-dimensional left ventricular outflow tract area measurements with transesophageal echocardiography after myectomy correlated fairly well with postoperative transesophageal pressure gradients. Patients with residual transthoracic elevated gradients after surgery at follow-up had a smaller transesophageal area and higher transesophageal pressure gradients immediately after the procedure. However, transesophageal pressure gradients after myectomy correlated poorly with follow-up transthoracic gradients at rest.</description><subject>Canada</subject><subject>Cardiomyopathy, Hypertrophic - diagnostic imaging</subject><subject>Cardiomyopathy, Hypertrophic - surgery</subject><subject>Echocardiography, Transesophageal</subject><subject>Humans</subject><subject>hypertrophic cardiomyopathy</subject><subject>intraoperative transesophageal echocardiography</subject><subject>left ventricular hypertrophy</subject><subject>left ventricular outflow obstruction</subject><subject>Mitral Valve Insufficiency</subject><subject>Retrospective Studies</subject><subject>three-dimensional echocardiography</subject><subject>Treatment Outcome</subject><subject>Ventricular Outflow Obstruction - diagnostic imaging</subject><subject>Ventricular Outflow Obstruction - surgery</subject><issn>1053-0770</issn><issn>1532-8422</issn><fulltext>true</fulltext><rsrctype>article</rsrctype><creationdate>2021</creationdate><recordtype>article</recordtype><recordid>eNp9kc2O0zAUhSMEYv54ARbISzYp_onrVGJTCjODVNRNh63l2DeqqyQO105HeQzeGFcdWLK6V1ffOdI9pyjeM7pgVIpPx8XxZM2CU54PfEFZ9aq4ZlLwsq44f533TJVUKXpV3MR4pJQxKdXb4kqISjCuxHXxex1jsN4kHwbyBdIzwED2BwQov_oehpjvpiNbaBP5CUNCb6fOINlNqe3CM9mjsYmsEQwxgyMPaJzPWCTrNgGSHzPYFPqZ-IE8ziNgwjAevCW7JiacbPInIBuDzmcojCYd5rviTWu6CO9e5m3xdP9tv3kst7uH75v1trRCLlNZ00bUnFMmoKLSAKtsUzlYMnBWtI6qWkmhlKiXzNbW1CvDm6aqBSjjjM3MbfHx4jti-DVBTLr30ULXmQHCFDWvlOJytZI0o_yCWgwxIrR6RN8bnDWj-hyyPupzFfpchWZc5yqy6MOL_9T04P5J_mafgc8XAPKXJw-oo83ZWXAec2raBf8__z_FwZ2r</recordid><startdate>202106</startdate><enddate>202106</enddate><creator>Moreno Garijo, J.</creator><creator>Amador, Y.</creator><creator>Fan, C.S.</creator><creator>Silverton, N.</creator><creator>Ralph-Edwards, A.</creator><creator>Woo, A.</creator><creator>Mashari, A.</creator><creator>Meineri, M.</creator><general>Elsevier Inc</general><scope>CGR</scope><scope>CUY</scope><scope>CVF</scope><scope>ECM</scope><scope>EIF</scope><scope>NPM</scope><scope>AAYXX</scope><scope>CITATION</scope><scope>7X8</scope><orcidid>https://orcid.org/0000-0002-4217-5453</orcidid><orcidid>https://orcid.org/0000-0002-1278-0118</orcidid><orcidid>https://orcid.org/0000-0001-8054-4662</orcidid><orcidid>https://orcid.org/0000-0002-8403-1271</orcidid></search><sort><creationdate>202106</creationdate><title>Association Between Three-Dimensional Left Ventricular Outflow Tract Area and Gradients After Myectomy in Hypertrophic Obstructive Cardiomyopathy</title><author>Moreno Garijo, J. ; Amador, Y. ; Fan, C.S. ; Silverton, N. ; Ralph-Edwards, A. ; Woo, A. ; Mashari, A. ; Meineri, M.</author></sort><facets><frbrtype>5</frbrtype><frbrgroupid>cdi_FETCH-LOGICAL-c356t-80b3822013e405ae14cb4de61edc3fd078753773861c8ca89a2bb483e7adacdc3</frbrgroupid><rsrctype>articles</rsrctype><prefilter>articles</prefilter><language>eng</language><creationdate>2021</creationdate><topic>Canada</topic><topic>Cardiomyopathy, Hypertrophic - diagnostic imaging</topic><topic>Cardiomyopathy, Hypertrophic - surgery</topic><topic>Echocardiography, Transesophageal</topic><topic>Humans</topic><topic>hypertrophic cardiomyopathy</topic><topic>intraoperative transesophageal echocardiography</topic><topic>left ventricular hypertrophy</topic><topic>left ventricular outflow obstruction</topic><topic>Mitral Valve Insufficiency</topic><topic>Retrospective Studies</topic><topic>three-dimensional echocardiography</topic><topic>Treatment Outcome</topic><topic>Ventricular Outflow Obstruction - diagnostic imaging</topic><topic>Ventricular Outflow Obstruction - surgery</topic><toplevel>peer_reviewed</toplevel><toplevel>online_resources</toplevel><creatorcontrib>Moreno Garijo, J.</creatorcontrib><creatorcontrib>Amador, Y.</creatorcontrib><creatorcontrib>Fan, C.S.</creatorcontrib><creatorcontrib>Silverton, N.</creatorcontrib><creatorcontrib>Ralph-Edwards, A.</creatorcontrib><creatorcontrib>Woo, A.</creatorcontrib><creatorcontrib>Mashari, A.</creatorcontrib><creatorcontrib>Meineri, M.</creatorcontrib><collection>Medline</collection><collection>MEDLINE</collection><collection>MEDLINE (Ovid)</collection><collection>MEDLINE</collection><collection>MEDLINE</collection><collection>PubMed</collection><collection>CrossRef</collection><collection>MEDLINE - Academic</collection><jtitle>Journal of cardiothoracic and vascular anesthesia</jtitle></facets><delivery><delcategory>Remote Search Resource</delcategory><fulltext>fulltext</fulltext></delivery><addata><au>Moreno Garijo, J.</au><au>Amador, Y.</au><au>Fan, C.S.</au><au>Silverton, N.</au><au>Ralph-Edwards, A.</au><au>Woo, A.</au><au>Mashari, A.</au><au>Meineri, M.</au><format>journal</format><genre>article</genre><ristype>JOUR</ristype><atitle>Association Between Three-Dimensional Left Ventricular Outflow Tract Area and Gradients After Myectomy in Hypertrophic Obstructive Cardiomyopathy</atitle><jtitle>Journal of cardiothoracic and vascular anesthesia</jtitle><addtitle>J Cardiothorac Vasc Anesth</addtitle><date>2021-06</date><risdate>2021</risdate><volume>35</volume><issue>6</issue><spage>1654</spage><epage>1662</epage><pages>1654-1662</pages><issn>1053-0770</issn><eissn>1532-8422</eissn><abstract>Determine whether the intraoperative three-dimensional left ventricular outflow tract cross-sectional area may be inversely correlated with pressure gradients as a determinant of surgical success after septal myectomy in hypertrophic cardiomyopathy patients.
Perioperative data were obtained by retrospective review.
Toronto General Hospital, University of Toronto, Toronto, Canada, a tertiary hospital.
The study comprised 67 patients with hypertrophic obstructive cardiomyopathy.
Transthoracic and intraoperative transesophageal echocardiographic assessment of pressure gradients. Transesophageal measurement of the three-dimensional left ventricular outflow tract cross-sectional area.
The smallest left ventricular outflow tract area increased on average 1.883 cm2 (98.3%) after septal myectomy. There was a significant correlation between the increase in the area and the transesophageal pressure gradients (r = –0.32; p = 0.01) after myectomy, but none with postoperative transthoracic gradients at rest (r = –0.10; p = 0.42). Postoperative transesophageal and transthoracic gradients were significantly correlated (r = 0.26; p = 0.04). The best risk factors to predict high residual gradients were preoperative transesophageal gradient >97 mmHg, postoperative transesophageal area <3.16 cm2, and moderate or more residual transesophageal mitral regurgitation (specificity 89%, 81%, and 78%, respectively).
Three-dimensional left ventricular outflow tract area measurements with transesophageal echocardiography after myectomy correlated fairly well with postoperative transesophageal pressure gradients. Patients with residual transthoracic elevated gradients after surgery at follow-up had a smaller transesophageal area and higher transesophageal pressure gradients immediately after the procedure. However, transesophageal pressure gradients after myectomy correlated poorly with follow-up transthoracic gradients at rest.</abstract><cop>United States</cop><pub>Elsevier Inc</pub><pmid>33431273</pmid><doi>10.1053/j.jvca.2020.12.014</doi><tpages>9</tpages><orcidid>https://orcid.org/0000-0002-4217-5453</orcidid><orcidid>https://orcid.org/0000-0002-1278-0118</orcidid><orcidid>https://orcid.org/0000-0001-8054-4662</orcidid><orcidid>https://orcid.org/0000-0002-8403-1271</orcidid></addata></record> |
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| subjects | Canada Cardiomyopathy, Hypertrophic - diagnostic imaging Cardiomyopathy, Hypertrophic - surgery Echocardiography, Transesophageal Humans hypertrophic cardiomyopathy intraoperative transesophageal echocardiography left ventricular hypertrophy left ventricular outflow obstruction Mitral Valve Insufficiency Retrospective Studies three-dimensional echocardiography Treatment Outcome Ventricular Outflow Obstruction - diagnostic imaging Ventricular Outflow Obstruction - surgery |
| title | Association Between Three-Dimensional Left Ventricular Outflow Tract Area and Gradients After Myectomy in Hypertrophic Obstructive Cardiomyopathy |
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