Surgical treatment of hypertrophic obstructive cardiomyopathy in pediatric patients with severe hypertrophy.

We have undertaken a study over a period of 5 years on 35 hypertrophic obstructive cardiomyopathy (HOCM) patients with severe hypertrophy in the age range between 8 and 15 years. The indication for surgery was based on the diagnosis of severe myocardial hypertrophy in association with serious cardiac failure (New York Heart Association class III or IV) or elevated intraventricular pressure gradients refractory to medical therapy. Furthermore, patients were considered for operation if they met a history of sudden death within their families. A new technique of HOCM surgical correction in pediatric patients with severe hypertrophy was proposed. Conceptually, this approach offers a number of advantages: it affords the excision of the asymmetrically hypertrophied area of the ventricular septum without penetration into the left ventricle cavity; it avoids mechanical damage to the heart conduction system and aortic valve; and for the surgeon, it improves visual inspection of the area to be resected. Here, we describe the disease history of 35 patients, their diagnostic evaluations, the surgical procedure, and the postoperational observations as well as the results of follow-up assessments. We state that the surgery was successful in all 35 cases. There were no early or late deaths. Acute postoperative pericarditis developed in three patients early after surgery. The follow-up period was 38 +/- 7 months, and complications were not observed so far.