Mitral Valve in Hypertrophic Cardiomyopathy
Mitral Valve in Hypertrophic Cardiomyopathy
The purpose of the study is to assess the role of mitral valve apparatus in the development
 of outflow tract obstruction in patients with hypertrophic cardiomyopathy and to identify the
 best surgical treatment modality to relieve outflow tract obstruction in such patients
It is well-known that mitral valve plays an important role in the development of left
 ventricular outflow tract obstruction in patients with hypertrophic cardiomyopathy. In order
 to further investigate this phenomenon, the following study aims to compare mitral valve
 geometry indices, as assessed by transthoracic echocardiography, two- and three-dimentional
 transesophageal echocardiography and mitral valve quantification analysis, and papillary
 musles' function, as assessed by 2D speckle tracking imaging, in patients with hypertrophic
 obstructive cardiomyopathy, patients with arterial hypertension and left ventricular
 hypertrophy and people without structural heart disease. This will provide information on the
 geometric characteristics of mitral valve that predispose to the development of obstruction.
 Futhermore, patients with hypertrophic obstructive cardiomyopathy that are eligible for the
 surgical relief of obstruction will be randomised into four groups according to the modality
 of intervention. These groups are as follows: 1) isolated extended septal myectomy; 2)
 extended septal myectomy + edge to edge mitral valve repair; 3) extended septal myectomy +
 posterior lealfet sliding plasty; 4) extended septal myectomy + secondary chordae
 transection. After surgery, said indices will be reassessed and the degree of outflow tract
 obstruction relief noted, in order to elicit which geometrical changes are produced by each
 type of intervention. Patients will be followed long-term, up to 5 years, in order to define
 whether the addition of the intervention on mitral valve helps abolish the residual gradient
 more effectively, and whether it translates into any survival benefit.
Inclusion Criteria:

 -  Age >18 years

 -  Signed informed consent to participate in the study

 -  For patients with hypertrophic cardiomyopathy only: resting or latent peak left
 ventricular outflow tract gradient >50 mmHg, NYHA class III-IV

 -  For patients with arterial hypertension only: hystory of arterial pressure increase
 >140/90 mmHg, increased left vantricular wall thickness (>10 mm) and myocardial mass
 indexed to BSA (>95 g/m2 for women and >115 g/m2 for men), as assessed by 2D
 transthoracic echocardiography

 Exclusion Criteria:

 -  Age < 18 years

 -  Persistent form of atrial fibrillation

 -  Intrinsic mitral or aortic valve disease

 -  Coronary artery disease

 -  Reduced left ventricular ejection fraction

 -  For control group only: presence of any structural heart disease