• J Moreno Garijo, Y Amador, C S Fan, N Silverton, A Ralph-Edwards, A Woo, A Mashari, and M Meineri.
• Department of Anesthesia and Pain Management, Toronto General Hospital, Toronto, ON, Canada. Electronic address: Jacobo.Moreno@uhn.ca.
• J. Cardiothorac. Vasc. Anesth. 2021 Jun 1; 35 (6): 1654-1662.

ObjectiveDetermine whether the intraoperative three-dimensional left ventricular outflow tract cross-sectional area may be inversely correlated with pressure gradients as a determinant of surgical success after septal myectomy in hypertrophic cardiomyopathy patients.DesignPerioperative data were obtained by retrospective review.SettingToronto General Hospital, University of Toronto, Toronto, Canada, a tertiary hospital.ParticipantsThe study comprised 67 patients with hypertrophic obstructive cardiomyopathy.InterventionsTransthoracic and intraoperative transesophageal echocardiographic assessment of pressure gradients. Transesophageal measurement of the three-dimensional left ventricular outflow tract cross-sectional area.Measurements And Main ResultsThe smallest left ventricular outflow tract area increased on average 1.883 cm2 (98.3%) after septal myectomy. There was a significant correlation between the increase in the area and the transesophageal pressure gradients (r = -0.32; p = 0.01) after myectomy, but none with postoperative transthoracic gradients at rest (r = -0.10; p = 0.42). Postoperative transesophageal and transthoracic gradients were significantly correlated (r = 0.26; p = 0.04). The best risk factors to predict high residual gradients were preoperative transesophageal gradient >97 mmHg, postoperative transesophageal area <3.16 cm2, and moderate or more residual transesophageal mitral regurgitation (specificity 89%, 81%, and 78%, respectively).ConclusionsThree-dimensional left ventricular outflow tract area measurements with transesophageal echocardiography after myectomy correlated fairly well with postoperative transesophageal pressure gradients. Patients with residual transthoracic elevated gradients after surgery at follow-up had a smaller transesophageal area and higher transesophageal pressure gradients immediately after the procedure. However, transesophageal pressure gradients after myectomy correlated poorly with follow-up transthoracic gradients at rest.Copyright © 2021. Published by Elsevier Inc.

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