Results of simultaneous myectomy and left ventricular apical aneurysm repair in patients with hypertrophic cardiomyopathy (2023)

Pregnancy in women with hypertrophic cardiomyopathy (HCM) is associated with a slightly increased risk of maternal morbidity and mortality and an increased risk of preterm delivery. One of the risk factors that complicate pregnancy in HCM is left ventricular outflow tract obstruction (LVOT). We present the case of a symptomatic patient with HCM and LVOS who was treated with alcoholic septal ablation and subsequently had an uncomplicated pregnancy.

In women with hypertrophic cardiomyopathy (HCM), pregnancy is associated with a slightly increased risk of maternal morbidity and mortality and an increased risk of preterm delivery. One of the factors that complicate pregnancy in these patients is the presence of dynamic left intraventricular obstruction (IVLO). We present the case of a patient with HCM and IVGOD who underwent alcoholic septal ablation and subsequently became pregnant without complications.

We present the definitive long-term course of a man with apical hypertrophic cardiomyopathy (ApHCM) who developed an apical aneurysm at 60 years of age. At age 33, his electrocardiogram (ECG) was nearly normal. T-wave inversions were first identified in leads V5-6 of an ECG at age 36. Echocardiography first showed left ventricular (LV) lateral wall hypertrophy at 37 years of age. At the age of 42, the echocardiogram showed a diastolic shell pattern in the LV cavity, confirming the diagnosis of ApHCM. At age 54, a late systolic apical gradient of 10 mmHg (velocity: 1.6 m/s) was evident. At age 60 he developed an apical aneurysm. Computed tomography of the heart did not show significant stenosis of the main coronary arteries. Thus, in our case, LV hypertrophy and apical hypertension in CMAP promoted the formation of an apical aneurysm without coronary artery disease.

<Purpose of learning:A high apical systolic flow velocity of ≥ 1.5 m/s in apical hypertrophic cardiomyopathy (ApHCM) on echocardiography may predict the development of an apical aneurysm and prompt us to consider medical intervention with beta-blockers or verapamil to prevent aneurysm formation to delay or prevent. As recent studies have shown that ApHCM may be less benign than previously thought, seeing ApHCM without medical attention can be dangerous.>

The advantages and disadvantages of classic risk factors in coronary artery disease (CHD) are widely discussed. We analyzed the role of conventional (age, sex, diabetes, hypertension, smoking) and non-conventional (anthropometry, fasting glycemia, atherogenic plasma index - AIP, family history) risk factors in Asian Indians with CAD.

Of 11,164 subjects (4855 affected, 6309 unaffected) enrolled in the Indian Atherosclerosis Research Study (IARS), 269 unaffected subjects with abnormal ECGs and seven minors were excluded. Approximately 10,888 individuals and two subgroups, including 9,888 individuals with family history information and 1,616 individuals with an average Framingham Risk Score (FRS), were statistically analyzed using SPSS software version 17.0 and R.

A combination of classical risk factors showed good discrimination between affected and unaffected individuals (C>0.85). Hypertension (OR 3.79) or male gender (OR 5.31) were significantly associated with CAD when lipids were included or excluded from the predictive model, followed by age, diabetes and smoking. Hypertension and diabetes were more common in older patients (>55 years), while smoking was more common in younger patients (<55 years). Family history and AIP revealed a modest increase in C-score relative to classic factors (0.864 to 0.873), with a net reclassification of 7.1% in the average FRS group. The FRS classified 4% of patients with CHD as high risk, 52% were classified as patients with metabolic syndrome using the revised criteria, and over 90% had a high AIP score.

Adding PAI and family history to conventional risk factors improved risk discrimination in Asian Indians with CAD.

Extracorporeal membrane oxygenation (ECMO) support for patients with cardiac or respiratory failure is increasingly used by advanced intensive care physicians. Thromboembolic complications of ECMO have been widely discussed and investigated; However, there is a lack of research and debate on the development, risks, and management of stent-associated fibrin sheaths.

Institutional Review Board approval was not required. We present three cases that describe the identification and individualized management of ECMO-associated fibrin sheaths at our institution. All three patients gave written informed consent to report their case details and imaging studies.

Of our three patients with ECMO-associated fibrin sheaths, two were successfully treated with anticoagulation alone. One was unable to receive anticoagulant therapy and an inferior vena cava filter was placed.

Fibrin sheath formation around ECMO cannulas is an unexplored complication of ECMO cannulas. We recommend an individualized approach to managing these fibrin sheaths and provide three examples of successful management.