HOCM by Dr. Mohamed A. Gabr Cardiac surgeon at Mansoura university 2019

1. HOCM
MOHAMED A. GABR
CARDIOTHORACIC SURGERY SPECIALIST AT MUH
MANSOURA UNIVERSITY 2019

2. DEFINITON
HCM is defined by the ↑↑ LV wall thickness ≥15 mm in one or
more LV myocardial segments.
measured by any imaging technique that is not solely explained
by abnormal loading conditions.
HCM is genetically determined heart muscle disease caused by mutations
in one of several sarcomere genes which encode components of the
contractile apparatus.

3. LVOTO
peak Doppler
LVOT pressure
gradient ≥ 30
mm Hg
Gradient ≥50 mm Hg : haemodyn. sig. LVOTO.

4. HISTORICAL PERSPECTIVE

6. ETIOLOGY

8. MORPHOLOGY

10. 1- IVS

12. 2- LV

13. 3- MV

15. 4- LA

16. 5- RV

17. 6- CORONARIES

19. HISTOPATHOLOGY

20. NORMAL HOCM

21. PATHOPHYSIOLOGY

23. DIAGNOSIS

24. 1- CLINICAL

25. 2- ECHO

27. 3- MSCT

29. 4- CMR

30. 5- CORONARY ANGIO.

31. COMPLICATIONS
Death: Sudden and non-sudden
Atrial dilatation: AF
Mitral valve disease: MR
Myocardial infarction
Pulmonary hypertension
Heart block and BBB

32. TREATMENT

34. 1- MEDICAL

35. NOVEL DRUGS
N-Acetylcysteine
RAAS Blockade
Statins
Perhexiline
Ranolazine
Eleclazine
Mavacamten

36. 2- SURGICAL

39. TASM

43. TMSM

46. MV intervention in SM

49. Combined TASM + Apical

52. COMPLICATIONS OF SM
Conduction disturbances: Complete heart block or RBBB
Perioperative Myocardial Infarction
Iatrogenic VSD
Postoperative Pressure Gradients
Residual Mitral Regurgitation
Death

53. 3- INTERVENTIONAL
ASA ICD MITRACLIP

54. ASA

56. Myectomy Vs. ASA ??

57. ICD

58. MITRACLIP

59. 4-LV-AORTIC CONDUIT

60. 5-TRANSPLANTATION

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References

62. THANK YOU