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Abstract Objective To analyze efficacy of septal myectomy combined with mitral valve replacement (MVR) in patients with hypertrophic obstructive cardiomyopathy(HOCM) and mitral regurgitation(MR). Methods Septal myectomy combined with MVR were performed in 24 patients with HOCM and MR. Septal myectomy was done through aortic incision in 9 cases and through left atrioventricular orifice in 15 cases. Trans- oesophagus echocardiograpy was used to evaluate improvement of outflow tract obstruction and MR during operation. Transthorax echocardiograpy was performed during fol ow- up. Results The left ventricular outflow tract gradient decreased from 103.79±16.69 mmHg to 19.46± 4.5mmHg(t=1.45, P<0.05) and the ventricular septal thickness decreased from 20.17±1.86mm to 10.5±1.12mm (t=1.97, P<0.05 ) after operation. During fol ow- up of (21.4±9.7)months, these changes were maintained, the left ventricular end diastolic dimension increased from 41.23 ±3.72mm to 48.72 ±3.9mm, and cardiac function improved from NYHA class 3.25 ± 0.37 to 1.58 ± 0.48 (t=1.71, P<0.05). Two cases had mild to moderate mitral paravalvular leak. There was no ventricular septal perforation,Ⅲdegree atrioventricular block and death. Conclusion Septal myectomy combined MVR is a safe and effective therapy with less injury and complication for HOCM with MR.
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