Long-term effect of modified Morrow surgery on hypertrophic obstructive cardiomyopathy in children: A retrospective study in a single center_Chinese Journal of Clinical Thoracic and Cardiovascular Surgery

Authors：

LI Xiaoyi ¹ , WU Hongxiang ¹ , WANG Ruobing ¹ , LIU Haozhong ¹ , ZENG Xiaodong ¹ , ZENG Ying ^1,3 , WANG Shengwen ¹ , HUANG Minjie ¹ , YUAN Haiyun ^1,2 , LIU Jian ^1,2 ,  GUO Huiming ^1,2

1. Department of Cardiac Surgery, Guangdong Institute of Cardiovascular Disease, Guangdong Academy of Medical Sciences, Guangdong Provincial People's Hospital, Southern Medical University, Guangzhou, 510080, P. R. China;
2. Guangdong Provincial Key Laboratory of Structural Heart Diseases in South China, Guangdong Academy of Medical Sciences, Guangdong Provincial People's Hospital, Southern Medical University, Guangzhou, 510080, P. R. China;
3. School of Medicine, South China University of Technology, Guangzhou, 510641, P. R. China;

Corresponding author：

GUO Huiming, Email: guohuiming@gdph.org.cn

Keywords：

Hypertrophic cardiomyopathy; children; interventricular septal cardiomyectomy; pacemaker

DOI：

10.7507/1007-4848.202309013

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Objective To analyze the long-term outcome of modified Morrow surgery (interventricular septal cardiomyectomy) in the treatment of hypertrophic obstructive cardiomyopathy (HOCM) in children. Methods The clinical data of the children with HOCM (aged≤14 years) who underwent modified Morrow surgery from January 2010 to August 2022 in Guangdong Provincial People's Hospital were retrospectively analyzed, including changes in hospitalization status, perioperative period, and long-term 15-lead electrocardiogram and echocardiography. Results A total of 29 patients were collected, including 22 males and 7 females, aged 10.00 (5.00, 12.00) years. Five (17.9%) patients had New York Heart Association (NYHA) heart function grade Ⅲ or Ⅳ. Ventricular septal cardiomyectomy was performed in all patients. All 29 patients survived and their cardiac function recovered after operation. Before discharge, right bundle branch block was observed in 2 patients and left bundle branch block in 6 patients. After surgery, in the left ventricular septal cardiomyectomy, the left atrial diameter decreased (P＜0.001), left ventricular end-systolic diameter increased (P=0.009), the peak pressure gradient of left ventricular outflow tract decreased (P＜0.001), and the thickness of ventricular septum decreased (P＜0.001). The systolic anterior motion of mitral valve disappeared and mitral regurgitent jet area decreased (P＜0.001). The flow velocity and peak pressure gradient of right ventricular outflow tract also decreased in the patients who underwent right ventricular septal cardiomyectomy. The average follow-up of the patients was 69.03±10.60 months. All the patients survived with their NYHA cardiac function grading Ⅰ or Ⅱ. No new-onset arrythmia event was found. Echocardiography indicated that the peak pressure gradient of the left ventricular outflow tract remained low (P<0.001). Moderate mitral regurgitation occurred in 2 patients, and left ventricular outflow tract obstruction with moderate mitral regurgitation occurred in 1 patient after simple right ventricular septal cardiomyectomy. Conclusion Right ventricular or biventricular obstruction is frequent in the children with HOCM and they usually have more symptoms before surgery. Modified Morrow surgery can effectively relieve outflow tract obstruction and improve their cardiac function. The long-term outcome is satisfactory. However, the posterior wall of the left ventricle remains hypertrophic. Also, there is an increased risk of a conduction block.

Citation： LI Xiaoyi, WU Hongxiang, WANG Ruobing, LIU Haozhong, ZENG Xiaodong, ZENG Ying, WANG Shengwen, HUANG Minjie, YUAN Haiyun, LIU Jian, GUO Huiming. Long-term effect of modified Morrow surgery on hypertrophic obstructive cardiomyopathy in children: A retrospective study in a single center. Chinese Journal of Clinical Thoracic and Cardiovascular Surgery, 2024, 31(7): 985-990. doi: 10.7507/1007-4848.202309013 Copy

1.	Arola A, Jokinen E, Ruuskanen O, et al. Epidemiology of idiopathic cardiomyopathies in children and adolescents. A nationwide study in Finland. Am J Epidemiol, 1997, 146(5): 385-393.
2.	Norrish G, Field E, Mcleod K, et al. Clinical presentation and survival of childhood hypertrophic cardiomyopathy: A retrospective study in United Kingdom. Eur Heart J, 2019, 40(12): 986-993.
3.	Norrish G, Cleary A, Field E, et al. Clinical features and natural history of preadolescent nonsyndromic hypertrophic cardiomyopathy. J Am Coll Cardiol, 2022, 79(20): 1986-1997.
4.	Miron A, Lafreniere-Roula M, Steve Fan CP, et al. A validated model for sudden cardiac death risk prediction in pediatric hypertrophic cardiomyopathy. Circulation, 2020, 142(3): 217-229.
5.	Gersh BJ, Maron BJ, Bonow RO, et al. 2011 ACCF/AHA guideline for the diagnosis and treatment of hypertrophic cardiomyopathy: A report of the American College of Cardiology Foundation/American Heart Association Task Force on Practice Guidelines. Circulation, 2011, 124(24): e783-e831.
6.	Ommen SR, Mital S, Burke MA, et al. 2020 AHA/ACC guideline for the diagnosis and treatment of patients with hypertrophic cardiomyopathy: Executive summary: A report of the American College of Cardiology/American Heart Association Joint Committee on Clinical Practice Guidelines. Circulation, 2020, 142(25): e533-e557.
7.	Norrish G, Kaski JP. The risk of sudden death in children with hypertrophic cardiomyopathy. Heart Fail Clin, 2022, 18(1): 9-18.
8.	Yingchoncharoen T, Tang WW. Recent advances in hypertrophic cardiomyopathy. F1000Prime Rep, 2014, 6: 12.
9.	O'Connor MJ, Miller K, Shaddy RE, et al. Disopyramide use in infants and children with hypertrophic cardiomyopathy. Cardiol Young, 2018, 28(4): 530-535.
10.	Maron MS, Olivotto I, Betocchi S, et al. Effect of left ventricular outflow tract obstruction on clinical outcome in hypertrophic cardiomyopathy. N Engl J Med, 2003, 348(4): 295-303.
11.	Morrow AG, Reitz BA, Epstein SE, et al. Operative treatment in hypertrophic subaortic stenosis. Techniques, and the results of pre and postoperative assessments in 83 patients. Circulation, 1975, 52(1): 88-102.
12.	Minakata K, Dearani JA, O'Leary PW, et al. Septal myectomy for obstructive hypertrophic cardiomyopathy in pediatric patients: Early and late results. Ann Thorac Surg, 2005, 80(4): 1424-1429.
13.	Altarabsheh SE, Dearani JA, Burkhart HM, et al. Outcome of septal myectomy for obstructive hypertrophic cardiomyopathy in children and young adults. Ann Thorac Surg, 2013, 95(2): 663-669.
14.	Laredo M, Khraiche D, Raisky O, et al. Long-term results of the modified Konno procedure in high-risk children with obstructive hypertrophic cardiomyopathy. J Thorac Cardiovasc Surg, 2018, 156(6): 2285-2294.
15.	Maron BJ, McIntosh CL, Klues HG, et al. Morphologic basis for obstruction to right ventricular outflow in hypertrophic cardiomyopathy. Am J Cardiol, 1993, 71(12): 1089-1094.
16.	Schaff HV, Dearani JA, Ommen SR, et al. Expanding the indications for septal myectomy in patients with hypertrophic cardiomyopathy: Results of operation in patients with latent obstruction. J Thorac Cardiovasc Surg, 2012, 143(2): 303-309.
17.	Quintana E, Johnson JN, Sabate Rotes A, et al. Surgery for biventricular obstruction in hypertrophic cardiomyopathy in children and young adults: Technique and outcomes. Eur J Cardiothorac Surg, 2015, 47(6): 1006-1012.
18.	Kaski JP, Kammeraad JAE, Blom NA, et al. Indications and management of implantable cardioverter-defibrillator therapy in childhood hypertrophic cardiomyopathy. Cardiol Young, 2023, 33(5): 681-698.
19.	Kaya E, Rassaf T, Wakili R. Subcutaneous ICD: Current standards and future perspective. Int J Cardiol Heart Vasc, 2019, 24: 100409.

1. Arola A, Jokinen E, Ruuskanen O, et al. Epidemiology of idiopathic cardiomyopathies in children and adolescents. A nationwide study in Finland. Am J Epidemiol, 1997, 146(5): 385-393.
2. Norrish G, Field E, Mcleod K, et al. Clinical presentation and survival of childhood hypertrophic cardiomyopathy: A retrospective study in United Kingdom. Eur Heart J, 2019, 40(12): 986-993.
3. Norrish G, Cleary A, Field E, et al. Clinical features and natural history of preadolescent nonsyndromic hypertrophic cardiomyopathy. J Am Coll Cardiol, 2022, 79(20): 1986-1997.
4. Miron A, Lafreniere-Roula M, Steve Fan CP, et al. A validated model for sudden cardiac death risk prediction in pediatric hypertrophic cardiomyopathy. Circulation, 2020, 142(3): 217-229.
5. Gersh BJ, Maron BJ, Bonow RO, et al. 2011 ACCF/AHA guideline for the diagnosis and treatment of hypertrophic cardiomyopathy: A report of the American College of Cardiology Foundation/American Heart Association Task Force on Practice Guidelines. Circulation, 2011, 124(24): e783-e831.
6. Ommen SR, Mital S, Burke MA, et al. 2020 AHA/ACC guideline for the diagnosis and treatment of patients with hypertrophic cardiomyopathy: Executive summary: A report of the American College of Cardiology/American Heart Association Joint Committee on Clinical Practice Guidelines. Circulation, 2020, 142(25): e533-e557.
7. Norrish G, Kaski JP. The risk of sudden death in children with hypertrophic cardiomyopathy. Heart Fail Clin, 2022, 18(1): 9-18.
8. Yingchoncharoen T, Tang WW. Recent advances in hypertrophic cardiomyopathy. F1000Prime Rep, 2014, 6: 12.
9. O'Connor MJ, Miller K, Shaddy RE, et al. Disopyramide use in infants and children with hypertrophic cardiomyopathy. Cardiol Young, 2018, 28(4): 530-535.
10. Maron MS, Olivotto I, Betocchi S, et al. Effect of left ventricular outflow tract obstruction on clinical outcome in hypertrophic cardiomyopathy. N Engl J Med, 2003, 348(4): 295-303.
11. Morrow AG, Reitz BA, Epstein SE, et al. Operative treatment in hypertrophic subaortic stenosis. Techniques, and the results of pre and postoperative assessments in 83 patients. Circulation, 1975, 52(1): 88-102.
12. Minakata K, Dearani JA, O'Leary PW, et al. Septal myectomy for obstructive hypertrophic cardiomyopathy in pediatric patients: Early and late results. Ann Thorac Surg, 2005, 80(4): 1424-1429.
13. Altarabsheh SE, Dearani JA, Burkhart HM, et al. Outcome of septal myectomy for obstructive hypertrophic cardiomyopathy in children and young adults. Ann Thorac Surg, 2013, 95(2): 663-669.
14. Laredo M, Khraiche D, Raisky O, et al. Long-term results of the modified Konno procedure in high-risk children with obstructive hypertrophic cardiomyopathy. J Thorac Cardiovasc Surg, 2018, 156(6): 2285-2294.
15. Maron BJ, McIntosh CL, Klues HG, et al. Morphologic basis for obstruction to right ventricular outflow in hypertrophic cardiomyopathy. Am J Cardiol, 1993, 71(12): 1089-1094.
16. Schaff HV, Dearani JA, Ommen SR, et al. Expanding the indications for septal myectomy in patients with hypertrophic cardiomyopathy: Results of operation in patients with latent obstruction. J Thorac Cardiovasc Surg, 2012, 143(2): 303-309.
17. Quintana E, Johnson JN, Sabate Rotes A, et al. Surgery for biventricular obstruction in hypertrophic cardiomyopathy in children and young adults: Technique and outcomes. Eur J Cardiothorac Surg, 2015, 47(6): 1006-1012.
18. Kaski JP, Kammeraad JAE, Blom NA, et al. Indications and management of implantable cardioverter-defibrillator therapy in childhood hypertrophic cardiomyopathy. Cardiol Young, 2023, 33(5): 681-698.
19. Kaya E, Rassaf T, Wakili R. Subcutaneous ICD: Current standards and future perspective. Int J Cardiol Heart Vasc, 2019, 24: 100409.

Chinese Journal of Clinical Thoracic and Cardiovascular Surgery

Long-term effect of modified Morrow surgery on hypertrophic obstructive cardiomyopathy in children: A retrospective study in a single center

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