Two Cases of Myocardial Resection in Aortic Valve Replacement for Hypertrophic Myocardium Associated with Aortic Stenosis

• Published in: THE JOURNAL OF JAPAN SOCIETY FOR CLINICAL ANESTHESIA Vol. 39; no. 5; pp. 516 - 523
• Main Authors: OBATA, Yumi, AMANO, Eriko, HAMABE, Kosuke, SAKAMOTO, Miki, TATEDA, Takeshi, INOUE, Soichiro
• Format: Journal Article
• Language: Japanese
• Published: THE JAPAN SOCIETY FOR CLINICAL ANESTHESIA 15-09-2019
• Subjects: Aortic valve stenosis; Hypertrophied myocardium; Left ventricular outflow tract obstruction; Morrow operation; Systolic anterior movement
• ISSN: 0285-4945; 1349-9149
• DOI: 10.2199/jjsca.39.516

Among patients with aortic valve stenosis（AS）, left ventricular outflow tract obstruction（LVOTO）due to myocardial hypertrophy and left ventricular outflow tract obstruction（LVOTO）after aortic valve replacement（AVR）, there are cases in which systolic anterior movement（SAM）remains in the systolic mitral valve. In addition to AVR in consultation with the surgeon in cases with cardiac muscle hypertrophy due to AS, Morrow surgery was added in case 1, and papillary muscle bundle resection was added in case 2. As there are no clear standard indications for Morrow surgery and papillary muscle bundle resection, accurately determining flow velocity of the left ventricular outflow tract on preoperative transthoracic echocardiography（TTE）and intraoperative transesophageal echocardiography（TEE）is important for predicting the risk of LVOTO and SAM. Decisions regarding the type of operation should be made in consultation with the surgeon based on the findings in the hypertrophic myocardium.