Hypertrophic Obstructive Cardiomyopathy

Hypertrophic Obstructive Cardiomyopathy

Patient Volume 2010

Total HOCM Outpatient Visits New Patients with HOCM

1,283 295

Hypertrophic obstructive cardiomyopathy (HOCM) is thickening of the lower chambers of the heart, especially of the septal muscle, which separates the right and left chambers of the heart. This condition may impede blood flow from the heart to the aorta. Cleveland Clinic uses a multimodality approach to diagnose and treat patients with HOCM that includes a physical exam, EKGs, chest X-ray and MRI. In addition, we are actively screening patients and their families for genetic abnormalities associated with this disease.

Surgical Volume and Outcomes 2010

Septal Myectomy for HOCM

Hospital Mortality

203 0.49%

Cleveland Clinic has one of the largest surgical practices for treating patients with HOCM. In 2010, our surgeons performed 203 septal myectomy surgeries with or without other procedures for patients with HOCM. Overall mortality was 0.49 percent.

Septal Myectomy

Volume 250

200

150

100

50

0 2006

2007

2008

2009

2010

During a septal myectomy, the surgeon removes septal muscle to widen the path for blood to leave the heart.

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Outcomes 2010

Septal Myectomy and Concomitant Procedure Distribution (N = 203) 2010 HOCM is an uncommon but serious problem, especially when associated with mitral valve dysfunction. In 2010, 39 percent of septal myectomies were performed in conjunction with a valve procedure.

39% Septal Myectomy + Valve +/- (N = 68)

Papillary muscles directed toward septum.

100%

37% Isolated Septal Myectomy (N = 89)

12% Septal Myectomy + Other (N = 26) 7% Septal Myectomy + Valve Surgery + Coronary Artery Bypass +/- (N = 7) 5% Septal Myectomy + Coronary Artery Bypass +/- other (N = 13)

Papillary Muscle Reorientation/Realignment

Volume 25

Maximal Intraventricular Septal Thickness 18 mm Maximal Intraventricular Septal Thickness > 18 mm Mortality (%)

20

15

10

5

0 2007

2008

2009

2010

Papillary muscles "reoriented" toward

mitral valves.

Papillary Muscle Reorientation/ Realignment

Some patients with HOCM who have outflow tract obstruction with minimal or mild hypertrophy may also have abnormal papillary muscle function. To treat this condition, Cleveland Clinic cardiovascular surgeons use a variety of mitral valve repair techniques, including reorienting the abnormally positioned or excessively mobile papillary muscles. This procedure was developed at Cleveland Clinic.

Sydell and Arnold Miller Family Heart & Vascular Institute

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