Summary
Hypertrophie obstructive cardiomyopathy (HOCM) is a special form of left ventricular
outflow tract obstruetion. Clinical experience demonstrates 2 different types of HOCM
of the left ventricle: the typical subaortic or subvalvular HOCM and the atypical
midventricular form of myocardial obstruetion. In a series of 108 patients operated
upon,96 had typical and 12 had atypical HOCM. Indications for surgical treatment were
increase of clinical Symptoms to class III or IV (NYHA) and unresponsiveness to drug
therapy (β-blocking agents, calcium-antagonists). The male :female ratio was 2:1.
The mean age in the group with typical HOCM was 38.8 years, in the group with atypical
HOCM 46.5 years.
Transaortic myectomy (n = 85) was the predominant surgical approach for relief of
isolated subaortic and midventricular obstruetion.
Patients with severe mitral insufficiency and mitral valve replacement were identified
as a problematic group.
The total hospital mortality was 8.3 % (9 of 108 patients), 7.9 % (7 of 96 patients)
in the typical group, and 16.7 % (2 of 12 patients) in the atypical group.
Postoperative cardiological follow-up indicates the superior effect of surgery as
compared to drug therapy. The late mortality for the medical group was 10% and for
the postoperative group 2.5%. These facts support our recommendation for the surgical
treatment of HOCM in symptomatic patients in clinical stages III and IV (NYHA).
Key words
HOCM - Typicai subaortic HOCM - Atypical midventricular HOCM - Surgical therapy -
Transaortic myectomy and myotomy
