Posted on Authorea 7 Jul 2020 — The copyright holder is the author/funder. All rights reserved. No reuse without permission. — https://doi.org/10.22541/au.159413639.92454990 — This a preprint and has not been peer reviewed. Data may be preliminary. in Ji Qiang obstructive hypertrophic cardiomyopathy of septal treatment transaortic the in for myectomy instruments surgical special of Application ih etiua uflwtatrqiigelreet ainswoudretspa ycoyvathe also were via sulcus myectomy interatrial through septal approach of underwent atrial obstruction left who the concomitant Patients via disease (6) or excluded. artery atrium and enlargement. right coronary procedure; through requiring concomitant approach Maze tract transseptal (4) modified obstruction outflow stenosis; LVOT concomitant ventricular aortic (3) (5) right severe surgery; grafting; limiting or valvular bypass disease severe previous requiring heart of (2) hypertensive calcification); presence degenerative, (rheumatic, to annulus and lesions secondary (MV) mitral provocation valve and mitral with were organic infective, (1) criteria or non-vasodilating ischemic, included: Inclusion rest with criteria reviewed. Exclusion therapy at were pharmacologic blockers. septal mmHg center channel maximum underwent this 50 to who in [?] refractory years instruments symptoms 18 gradients surgical LVOT [?] special aged maximum patients of the HOCM aid consecutive the 2019, with March myectomy and 2016 March Between HOCM. for option Patients treatment surgical 2.1 promising special a of be aid may the thus with myectomy and septal results, transaortic reproducible The and Conclusions: favorable (p=0.739). achieved events instruments adverse major of incidence the p the a 57.7%, from p with sharply preoperatively, decreased occurred gradients 3.0 deaths maximum and follow-up (vs. The No block status. months. atrioventricular (11.5 functional value 6 Association complete was preoperative Heart developed York time patients New received follow-up follow-up in patients (3.0%) median improvement (5.4%) and Five significant The Nine in-hospital implantation. Results: 0.6%. pacemaker compared. Intraoperative, was was permanent instruments. mortality surgeon required per Surgical surgical events surgery. special adverse repeat major of of immediate 56.8 aid incidence mean The the Methods: analyzed. males, with were (HOCM). (83 cardiomyopathy results myectomy patients obstructive HOCM septal hypertrophic myectomy 168 of transaortic septal 2019, treatment transaortic isolated March the of and repeatability for and and instruments 2016 approaches efficacy March surgical myectomy the Between special improving evaluate of regarding to aid aimed studies the study further This with stimulated myectomy. has of difficulty difficulty the technical reducing High aim: and Background Abstract 2020 7, July 4 3 2 1 Wang hnsa optl ua University Fudan Hospital, Zhongshan University Fudan Hospital Zhongshan University, Fudan Hospital Zhongshan hnhiMncplIsiuefrCrivsua Diseases Cardiovascular for Institute Municipal Shanghai 4 < .0) nadto,n infiatdffrnewsfudaogsxsren ihvre prto oueregarding volume operation varied with surgeons six among found was difference significant no addition, In 0.001). 1 ui Wang Yulin , ± < .0)wt infiatrdcini h rprino oeaeo oergriain(.%vs. (1.2% regurgitation more or moderate of proportion the in reduction significant a with 0.001) . mgv.94.4 vs. mmHg 7.4 2 eYang Ye , 2 ± a lai hao , 26mH,p mmHg, 22.6 3 eJnDing WenJun , 1 < .0) h eindge fmta eugtto elt 1.0 to fell regurgitation mitral of degree median The 0.001). 1 ii Xia LiMin , ± 23yas eeicue h underwent who included were years) 12.3 β- lcesado calcium and/or blockers 1 n ChunSheng and , Posted on Authorea 7 Jul 2020 — The copyright holder is the author/funder. All rights reserved. No reuse without permission. — https://doi.org/10.22541/au.159413639.92454990 — This a preprint and has not been peer reviewed. Data may be preliminary. eiulmdrt rmr Ro favnrclrspa eeto etvnrclrfe alrpuewas rupture wall free ventricular left a myectomy or following defect gradient septal maximum a ventricular and/or as a obstruction LVOT defined if following was residual and MR or was obstruction carefully of MR Residual there severity were if the more observed. valves and performed or gradients aortic immediately maximum moderate was and the residual measure procedure mitral to repeat tract, bypass A off outflow throughmyectomy. weaning the after looking used by then, was seen TEE And be should the also PMs root. of were release the excision aortic anomalies PM reexplored. of The the subvalvular hypertrophic thoroughly bases of septum. of mitral the and apex the completed, cutting, incision addition, of the were chordae In the thickness toward resections secondary After the basal and retracted required. the to PMs resection. cutting, was leftwards of and/or of cords extending 50% mass bases false and to whole the including valve up was a beyond corrected, aortic was resection lengthened as the resection was Scalpel muscles below of excision mm depth hypertrophic cavity. resection. septal 5 The ventricular the of cusp, left heart. during area right the the used the The of were of inspection trigone. 1) nadir to better left Figure the access apparatus. achieve subvalvular gain at in to mitral to started shown used and up usually (as were leaflet, pulled instruments magnification were MV surgical loupe approxi- leaflets anterior Special and valve aortotomy muscle, aortic lamp oblique cardiac low the head hypertrophic left a ostium, A the a coronary Through tract, with right vein. outflow established the pulmonary the was above superior cannulation mm right mitral atrial 7-10 the right and sternotomy,mately with via and function, incision placing aortic median as vent a ascending well by ventricular with exposed as were bypass anatomy aorta cardiopulmonary ascending reverse MV and and the thickness, heart in the as anaesthesia, put general well was Under atten- as patient particular anatomy The with septal anatomy. (TEE), subvalvular ventricular echocardiography to transesophageal paid surgeon intraoperative tion by per guided 1. events were file adverse Operations additional major the in of perioperative shown procedures characteristics, incidence are Surgical 6 surgical events the 2.4 characteristics, adverse and addition, baseline major 3 of In and at obtained details results, up were follow-up The telephone. followed data results, compared. Follow-up or regularly and WeChat, were intervals. calculated Patients visit, 6-month was at clinic form. thereafter a collection and by data respectively, staff, database standard surgery, institutional trained following our a The from months using obtained reviewed were people). results were (two perioperative and staff study. and characteristics, this trained surgical of by and and purpose Baseline performed University the Fudan was of collection Hospital informed Data Zhongshan not were of however, committee. committee ethics ethics the the by by the with approved consistent was was protocol study This mobility. and PM morphology protocol PM and of Study thickness, characterization reso- PM 2.3 for cavity, magnetic ventricular and cardiac thickness left addition, septal the In basal within measure used. location to frequently used were frequently stand-to-squat was and nance and maneuver modified Valsalva window, Resting the the apical as using annulus. an such by mitral from estimated and tract was leaflets 4v outflow gradient mitral = the leaflet); pressure of of valve LVOT lesions Doppler mitral resting continuous-wave including anterior the by pap- disease the measured and MV into was body, intrinsic velocity leaflet insertion of LVOT mitral mitral presence direct anterior the of and the (5) (hypertrophy, presence wall on and distri- abnormalities free the inserted the (PM) or chordae (4) septum secondary (2) muscle function; ventricular retracted provocation; illary the and and with to anatomy fibrotic attached and cords), MV tendineae rest (false chordae (3) at abnormal hypertrophy; location including both myocardial anomalies the gradient, subvalvular of (1) pressure severity ventricular define and left to bution any performed of was magnitude examination and (TTE) echocardiography transthoracic Preoperative evaluation Preoperative 2.2 2 hr ekLO eoiy.I ainswt etn VTgradients LVOT resting with patients In velocity). LVOT peak = v where , elrto fHelsinki of Declaration l nlddptet inda nomdcnetapproved consent informed an signed patients included All . 2 Trendelenburg n etltrldcbtsposition. decubitus lateral left and Bernoulli < qain(.. gradient (i.e., equation 0mH,maneuvers mmHg, 30 > 0mmHg. 30 Posted on Authorea 7 Jul 2020 — The copyright holder is the author/funder. All rights reserved. No reuse without permission. — https://doi.org/10.22541/au.159413639.92454990 — This a preprint and has not been peer reviewed. Data may be preliminary. ains fwo n a dnie smdrt R oisacso oeta oeaeM were MR moderate than more of instances No than MR. outcomes lower moderate In-hospital significantly 3.3 as were which identified of was both one mm, observed. whom 2.1 mmHg of +- 6.3 patients, +- 13.8 (p 10.8 of values to thickness preoperative fell myectomy the repairs septal following underwent interventricular gradients patients respectively. LVOT the 2 maximum perforation, with the remaining iatrogenic that the to transaortic showed and due received examination valve rupture; TEE of and right wall repair free aortic patients) underwent to and patients (4 the due defect 2 and findings rupture septal from another myectomy, TEE wall of patient); direction septal free (one to leftward identified ventricular technique initial and/or according left were “edge-to-edge” length inadequate a MV the patients and using to the 5 repair depth toward due valve them, of wall mitral MR Of terms free more in ventricular patients. myectomy or left extended (5.4%) moderate “more” 9 or a in obstruction underwent recorded LVOT was residual procedure as repeat immediate to The addition (29 in cutting procedures chordae results patients). secondary Intraoperative subvalvular (13 retracted 3.2 mitral resection 8.1 and and/or received +- fibrotic release 36.0 patients patients), M of (11 (26.8%) and time cutting patients), 45 cross-clamping cords aortic false mean min). including myectomy, a 35.0 with (13 myectomy (median, abnormalities septal minutes PM transaortic and underwent patients), patients (29 All including chordae patients, secondary (26.8%) retracted 45 of was in and patients, identified obstruction fibrotic all patients). were midventricular patients), Importantly, in anomalies (11 subvalvular MR. observed interven- Mitral cords was more mean false patients. or (SAM) a (4.2%) motion moderate 7 with anterior with in mmHg Systolic diagnosed recorded 22.6 were 3.1mm. +- (57.7%) +- 94.4 97 18.3 severe of whom of gradient manifested LVOT thickness maximum patients population. septal Association mean the tricular Heart All a York of revealed New 86.3% respectively. examination with in TTE IV patients, syncope, and and (2.4%) pain III 4 chest class angina-like Nine functional and block dyspnea, hypertrophy. (NYHA) patients branch years. ventricular as bundle 12.3 such of (8.3%) right +- symptoms, cause and history 14 limiting primary 56.8 a fibrillation in Atrial had the of population be ablation. age recorded the to septal mean of were alcohol enough 39.9% a previous for severe that underwent with deemed fact patients patients patients the not (5.4%) eligible Despite female was 168 85 it 1. Table left hypertension, and septal in of which patients listed undergoing are male patients), characteristics and excluded 83 (8 baseline patients), were were The atrium (3 There (2 patients right procedure Forty tract analysis. Maze through reviewed. outflow concomitant data approach were patients), ventricular transseptal criteria (27 right via inclusion surgery of myectomy requiring the enlargement disease met concomitant heart who patients), valvular patients concomitant adult to 208 due of total A population Study 3.1. the with groups between Results compared 3. were and two-sided A (IQR) test. range sum interquartile rank and mean median the independent-samples as expressed an as using expressed groups IL, were compared between Chicago, were variables Inc., and continuous (SPSS percentages single 22.0 distributed and version distributions package using frequency groups statistical as between expressed SPSS were the data with Categorical USA). performed was analysis Statistical analysis Statistical 2.5 Fisher’s < p .0) orsda btuto a eodd A a bevdi 6(9.5%) 16 in observed was SAM recorded. was obstruction residual No 0.001). vlels hn00 a osdrdsaitclysignificant. statistically considered was 0.05 than less -value xc eti h xetdfeunywas frequency expected the if test exact t ts;nnnral itiue otnosvralswere variables continuous distributed non-normally -test; 3 ± tnaddvainadwr compared were and deviation standard < rthe or 5 chi-square et Normally test. Wilcoxon Posted on Authorea 7 Jul 2020 — The copyright holder is the author/funder. All rights reserved. No reuse without permission. — https://doi.org/10.22541/au.159413639.92454990 — This a preprint and has not been peer reviewed. Data may be preliminary. endrto fari rs-lmigws3. -81mnts(ein 50mn,wihwssignificantly was which min), 35.0 (median, the minutes instruments, 8.1 surgical +- special 36.0 of was aid cross-clamping the with aortic surgical procedures of special myectomy duration of transaortic of mean aid 168 including reduction the series with reliable this myectomy HOCM. a in In septal symptomatic improvement and transaortic of significant obstruction of treatment LVOT a efficacy LVOT the of and and of in relief survival safety relief instruments effective effective the good an an confirmed observed II, which with The and MR, coincided MR. I status of class functional functional reduction NYHA NYHA reliable and a surgical symptoms and low from a recovery obstruction, including with achieved, life were pa- of 168 results quality Favorable in dysfunction performed symptoms. was systolic myectomy refractory ( and septal drug mortality dilation transaortic wall and instruments, ventricular HOCM enhances surgical left with special and of of tients presence aid geometry the the ventricular with in study, maintains helpful this treatment chordae be the may secondary for which myectomy the thickening, septal because shallow pro- controversial al a et to remained Ferrazzi addition 2015, by in In HOCM guided cutting myectomy chordae procedure. of myectomy secondary septal decades, septal transaortic extended extended next the the TEE more posed the of a intraoperative application Over to clinical and limited operation operation. resonance however, proximal Morrow the Morrow magnetic from classic classic cardiovascular muscle the of as preoperative amount from described small evolved a generally has all of technique myectomy resection among transaortic a found reported have septum, was al ventricular et difference Morrow significant 1960s, the no In 3, Table (p=0.739). in events obstruction shown adverse Discussion residual As major (5), of respec- incidence (2). 10, block were the and atrioventricular MR events regarding 13, adverse complete residual surgeons 14, major patient), moderate 23, 11 (one 36, of and total 72, death (3), A of surgical procedures. period including myectomy three-year septal recorded, the transaortic during 168 dynamic completed procedures and have of tively) number I, surgeon (total class per surgeons events NYHA Six adverse as major categorized asymptomatic of was 2-mm Incidence patient one 3.5 have The to preoperative found follow-up. continued. the was was during receive than evaluation follow-up intraoperatively lower not defect latest significantly perforation did septal the was septal patients ventricular at which iatrogenic MR 3 symptoms, p developed moderate the no 57.7%, 2, who However, with Table vs. patients in respectively. (1.2% (1.2%) summarized value mmHg, 2 As in 42 ablation. maximum recorded and septal the was alcohol with mmHg, obstruction or 39 residual surgery as mmHg, repeat identified than were 34 lower patients significantly months. of Three were gradients (6-13) gradients LVOT 3). maximum (Figure 6 the values showed preoperative of follow-up the values, latest duration the preoperative IV. at the median examination or from TTE improved a III significantly class were with class re-interventions being functional or visit patients NYHA deaths 2, no follow-up no Figure with and a in disappeared, shown received manifestations As clinical patients observed. the periods, (95.8%) follow-up 161 the During of total A are complications postoperative other results The Follow-up 3.4 days. discharged, 6 were was patients stay 2. 167 4 Table hospital the of in postoperative all total but of listed A bundle fibrillation, length right cardioversion. atrial median had electrical new-onset the 3 following developed and patients, rhythm patients sinus 5 (2.4%) acute the to 4 with of returned Another that patients associated surgery. Note to be prior implantation. may atrioventricular pacemaker block complete which branch permanent developed postoperatively, patients required day (3.0%) and Five fourth block 0.6%. the node was mortality on surgical hernia and infarction, cerebral cerebral of died patient One < [8] % ihn curne fdah rr-nevnin tflo-p infiatipoeetof improvement significant a follow-up, at re-interventions or deaths of occurrences no with 1%) twsrpre ob soitdwt aoal results favorable with associated be to reported was It . < .0) hr een ae fsvr Ra olwu.Nt htoepatient one that Note follow-up. at MR severe of cases no were There 0.001). 4 8 19] [8, [15-18] oee,sc napproach an such However, . ihtcncldifficulty, technical High . [20] In . Posted on Authorea 7 Jul 2020 — The copyright holder is the author/funder. All rights reserved. No reuse without permission. — https://doi.org/10.22541/au.159413639.92454990 — This a preprint and has not been peer reviewed. Data may be preliminary. n erdcbersls n hsmyb rmsn ramn pinfrHOCM. for option treatment promising myec- a favorable achieved of be References instruments difficulty may surgical technical thus special and the of results, reducing aid the reproducible to with contribute and procedure may myectomy instruments septal Transaortic surgical tomy. special of application The confirm to observation utilized longer 6- not needed the were It as questionnaire, Conclusion short. such SF-36 relatively the tool, was examination as follow-up assessment regular such of capacity findings. a tool, duration functional assessment our the as a Finally, life serve Third, study. of not quality this institution. did in a our it and minor at test, as a walking times imaging, only minute early Second, resonance study the results. magnetic observational the in cardiac single-armed of modality generalizability received single-center, the patients a influenced extend have was of may to this which part size, enough First, sample large the limitations. limited a not with potential distance. with was some associated certain that had a be patch study at may This small perforation and the the follow-up and of during edge perforation pericardium observed the the bovine beyond was a of a using defect with surrounding repaired years myocardium septal was 70 hypertrophy, ventricular perforation thin aged the septal patient residual Although severe female were a without one mm. perforation patients patch, in 17.0 old septal occurred of and iatrogenic thickness perforation roots septal septal and ventricular aortic preoperative injury series, small valve associated this with muscles aortic In patients be papillary principle, young not respectively. abnormal In to in Although that exploration occur bundles. incision made. operative to muscle was via the prone sinus of indicated when aortic was excision right rupture commissure the the wall anterior with stab of may free ventricular mitral nadir rupture a wall left the control the free corrected, of to ventricular to were right Left described the resection technique artery. to subaortic coronary just the excessive a began to to with similar myectomy successfully proximity associated fashion, was close mattress be and in ventricular horizontal heart suture patients, left a the polypropylene (1.2%) 3-0 to series, in 2 wound double-armed placed this a in pledget with In occurred arrest a conservative myectomy, cardioplegic with block. of after and bypass branch adoption complication patients cardiopulmonary bundle of rare the under 41.0% right treated allowed a than preoperative More which rupture, myectomy, with wall made. was after patients free sinus block in aortic of in- right branch strategies the the incidence when bundle of surgical valve the nadir noncoronary left the the cohort, complete of of right side present series developed the the large the to to just other resection sep- In subaortic beginning on iatrogenic excessive cision based myectomy. the and to expected septal attributed injury than was of valve greater incidence complications was aortic (3.0%) main rupture, implantation the wall pacemaker were free reproducible ventricular perforation and left tal good block, with atrioventricular HOCM, Complete for the option treatment during regarding instruments promising surgeons surgical a special six of be procedures. results. among application myectomy may the found myectomy 168 that was septal suggested completed which difference transaortic have events, significant adverse volume major no operation of and incidence varied achieved, greatly adequate were with an effect results Favorable surgeons surgical surgeon, for myectomy to six beneficial a important is addition, extremely for instruments In is essential the surgical which is of extend special radius excision, to operator of operational septal even the small application of PMs, the of the length to of comfort attribute Moreover, base may surgical These the instruments. The at surgeon. special myectomy ventricle. myocardium inexperienced left the an remove for the especially to of application easy apex the it that the suggested made to results Favorable instruments transaortic underwent surgical instruments. and surgical special obstruction special midventricular of of from time. aid suffered the operation series with this shortening myectomy in septal and patients myectomy HOCM of 7 same that challenges the Note technical in the center myectomy reducing experienced in and beneficial famous be a from reported min) 68 country (median, value the than lower [21] h esnfrti ieec a eta h plcto fseilsria ntuet may instruments surgical special of application the that be may difference this for reason The . 5 [14] . 2,23] [22, hselevated This . Posted on Authorea 7 Jul 2020 — The copyright holder is the author/funder. All rights reserved. No reuse without permission. — https://doi.org/10.22541/au.159413639.92454990 — This a preprint and has not been peer reviewed. Data may be preliminary. SiioP iaoI ogoD yinvA rloM ezl ,e l oeo roeaiecardiovascular preoperative of Role al. et L, Pezzoli M, Grillo A, Zyrianov D, Poggio remod- I, ventricular Binaco Right P, Spirito al. et 17. MM, Gurzun AD, Mateescu R, Enache in CC, surgery Beladan A, of Calin Benefits M, Rosca medicine. 16. cardiovascular recur- in and Controversies Residual JA. Dearani al. M, et Yacoub MD, BJ, Abel Maron JA, 15. Dearani RA, Nishimura HV, Schaff E, Quintana YH, guideline ACCF/AHA Cho 2011 14. al. et MS, Link MA, Fifer JA, Dearani RO, Bonow BJ, Maron BJ, Gersh Guidelines 13. ESC 2014 al. do et P, to Charron call F, Cecchi clarion M, A Borggrefe MA, year? Borger per A, Anastasakis case ef- PM, one Elliott Current – 12. cardiomyopathy al. Hypertrophic et RA. RK, Nishimura Kaple SR, G, Ommen Krishnaswamy 11. J, Rajeswaran HM, Lever BW, Lytle NG, Smedira 10. Icvn ,SiioP io ,IsoeM iDdaG eFlpoP ta.Acneprr European contemporary A al. et P, Filippo De G, Dedda Di M, Iascone C, Simon cutting: P, chordal Spirito Transaortic A, Iacovoni al. et 9. C, Simon K, igliorati A, Calabrese for A, myectomy Iacovoni P, Septal Spirito insight: P, Ferrazzi Surgery GK. 8. Danielson HV, Schaff BJ, Gersh SR, Ommen long-term JA, of Predictors Dearani al. 7. et BW, Lytle M, Thamilarasan P, survival Naji NG, Long-term Smedira A, al. Bhonsale et MY, A, Desai Ralph-Edwards 6. echocar- M, Linghorne and Ed, Clinical Wigle H, al. Rakowski et J, K, Ivanov of Fedwick W, effects Ball E, Long-term Rozenblyum 5. ED, al. Wigle R, et Choi S, WG, Betocchi Williams F, A, Cecchi Woo MS, 4. Maron I, Olivotto ver- myectomy BJ, Surgical Maron al. SR, et JA, Ommen Dearani 3. JB, Geske RA, Nishimura volume D, Hospital Hang HV, al. Schaff et A, G, Nguyen Bergman 2. SC, Wong RM, Minutello P, Looser RV, Swaminathan LK, Kim 1. antcrsnnei lnigvnrclrspu ycoyi ainswt btutv hypertrophic obstructive with patients in myectomy Echocardiogr septum ventricular Soc planning in Am resonance J magnetic cardiomyopathy. hypertrophic in impact 1329-38. clinical 28: its 2015; and Eur correlates, its patients. eling, European for 1055-8. back myectomy 32: 2011; septal J bring Heart cardiomyopathy: 909-916. hypertrophic 148: obstructive 2014; Surg Cardiovasc and Thorac obstruction J of cardiomyopathy-mechanisms reoperation. hypertrophic of for outcomes myectomy of septal report after gradients Practice a rent on Force summary: Task 2761-96. executive Association 124: Heart cardiomyopathy: 2011; Foundation/American Circulation hypertrophic Cardiology Guidelines. of of College treatment American and the diagnosis the Diagnosis for Eur the (ESC). for Cardiology Force of 2733-79. Society Task 35: European the 2014; the J of Cardiomyopathy: Cardiomyopathy Heart Hypertrophic Hypertrophic of of Management Management and and Diagnosis 333-4. on 1: 2016; Cardiol JAMA right. Ann is cardiomyopathy. what obstructive hypertrophic 127-33. for myectomy 85: septal 2008; Surg isolated Thorac of risks and fectiveness 2080- 33: 2012; J Heart Eur cardiomyopathy. hypertrophic 7. in myectomy septal surgical Am with J experience hypertrophy. septal 1687-99. mild with 66: cardiomyopathy 2015; hypertrophic Cardiol obstructive Coll for repair valve mitral Med Cardiovasc Pract 503-12. Clin Nat 4: 2007; experience. Clinic 209-1. Mayo cardiomyopathy–the 128: hypertrophic obstructive 2013; Circulation obstruction. relief tract surgical outflow undergoing ventricular patients left cardiomyopathy obstructive of hypertrophic symptomatic 2313-21. in versusoutcomes 58: conservative 2011; of Cardiol comparison Coll Am cardiomyopathy: J hypertrophic obstructive treatment. invasive resting hypertrophic with obstructive patients in in myectomy surgical 2033-41. after 111: survival 2005; Circulation long-term cardiomyopathy. of determinants diographic Am J cardiomyopathy. 470-6. hypertrophic obstructive 46: with 2005; patients Cardiol in Coll survival on myectomy e3. septal 306-15. surgical score-matched 157: propensity 2019; A Surg cardiomyopathy: Cardiovasc hypertrophic Thorac obstructive J for cohort. 324-32. ablation 1: septal 2016; alcohol hypertrophic Cardiol sus obstructive JAMA of 2003-2011. treatment Database, for Inpatient ablation Nationwide septal US alcohol and cardiomyopathy: myectomy septal after outcomes 6 Posted on Authorea 7 Jul 2020 — The copyright holder is the author/funder. All rights reserved. No reuse without permission. — https://doi.org/10.22541/au.159413639.92454990 — This a preprint and has not been peer reviewed. Data may be preliminary. hypertrophic-obstructive-cardiomyopathy of-special-surgical-instruments-in-transaortic-septal-myectomy-for-the-treatment-of- 3.docx Table file Hosted hypertrophic-obstructive-cardiomyopathy of-special-surgical-instruments-in-transaortic-septal-myectomy-for-the-treatment-of- 2.docx Table file Hosted hypertrophic-obstructive-cardiomyopathy of-special-surgical-instruments-in-transaortic-septal-myectomy-for-the-treatment-of- h auso h e ierpeettema aiu rdet.LO,lf etiua uflwtract. outflow ventricular 1.docx left LVOT, Table gradients. maximum mean the file represent Hosted line red the gradients. LVOT of values maximum The post-operative and Pre- 3. Figure class. functional right). (the NYHA scissors P post-operative surgical arm and long Pre- and left) 2. (the Figure forceps surgical long include instruments surgical Special instruments surgical Special 1. Figure Legend Figure < Hde ,RvsC,Aulr ,Bre ,Aah ,Baktn H ta.Sria management Surgical al. et EH, Blackstone A, Alashi R, Borden J, Aguilera CG, Rivas K, as Hodges outflow bundles ventricular 23. muscle Left anomalous al. et of M, Excision Thamilarasan J, Rizzo al. NG, Smedira et ZB, J, Popovic A, Wang Dhillon P, C, Patel Zhu 22. H, Chen Q, Yu mitral H, of Cui Importance S, al. Wang et A, 21. Cheng MK, Zasio FA, Tibayan KB, Harrington F, Langer F, managementRodriguez Current 20. M. Trofin M, Alexandrescu A, Dermengiu M, Greavu septal R, for Ticulescu printing L, 3-dimensional Dorobantu Myocardial TH. 19. Lim JW, Lee JK, Song N, Kim JW, Kang DH, Yang 18. .0,NH ucinlcaspirt ycoyv.NH ucinlcasa h aetfollow-up. latest the at class functional NYHA vs. myectomy to prior class functional NYHA 0.001, flf etiua uflwtatosrcini pcaie yetohcosrciecardiomyopathy 2289-2299. obstructive 157: hypertrophic 2019; specialized Surg a Cardiovasc in Thorac obstruction J tract center. outflow ventricular resonance left magnetic of cardiac using assessed abnormalities impli- muscle hypertrophy: papillary septal echocardiography and severe and valve tract without mitral patients outflow of cardiomyopathy ventricular cations hypertrophic left in of obstruction 461-468. tract treatment 152: for 2016; myectomy Surg Cardiovasc septal Thorcac extended J to obstruction. addition important an systolic global II115-22. and 110: mechanics, thickening 2004; wall Circulation geometry, ventricular function. left for chordae second-order valve 77: 2019; Pol Kardiol cardiomyopathy. obstructive hypertrophic with 829-836. patients in advances surgical and 132: 2015; Circulation cardiomyopathy. hypertrophic obstructive with 300-1. patient a in guidance myectomy 1517-26. 123: 2019; Cardiol J Am cardiomyopathy. vial at available at available vial at available . icCrivs mgn 05 :e003132. 8: 2015; Imaging Cardiovasc Circ https://authorea.com/users/339425/articles/465654-application- https://authorea.com/users/339425/articles/465654-application- https://authorea.com/users/339425/articles/465654-application- . 7 Posted on Authorea 7 Jul 2020 — The copyright holder is the author/funder. All rights reserved. No reuse without permission. — https://doi.org/10.22541/au.159413639.92454990 — This a preprint and has not been peer reviewed. Data may be preliminary. 8 Posted on Authorea 7 Jul 2020 — The copyright holder is the author/funder. All rights reserved. No reuse without permission. — https://doi.org/10.22541/au.159413639.92454990 — This a preprint and has not been peer reviewed. Data may be preliminary. 9