Herz
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The natural history of hypertrophic obstructive cardiomyopathy is characterized, in particular, in younger patients by sudden cardiac death, in the majority of patients by progressive congestive heart failure [14, 26, 27, 33-36]. With the aid of beta-adrenergic receptor blockers, calcium channel blockers and antiarrhythmic agents the clinical outlook for most of the patients can be improved [17, 19, 23, 28]. Patients who do not respond to medical treatment can be regarded as possible candidates for surgical revision of the left ventricular outflow tract. ⋯ An overview of the variety of surgical approaches and procedures employed for hypertrophic obstructive cardiomyopathy is provided by Table 1. From initial attempts to eliminate the outflow tract obstruction by myotomy, the subvalvular myectomy was developed in which an about 1 cm wide section of muscle is resected; this procedure can be carried out from a transaortic, transatrial or transventricular approach [4, 9, 21, 22, 24, 38, 39, 47]. Under the assumption that the anterior motion of the anterior mitral valve leaflet contributes to systolic obstruction, some authors recommended reconstructive procedures or replacement of the mitral valve.(ABSTRACT TRUNCATED AT 400 WORDS)
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Noninvasive and invasive diagnostic procedures permit a differentiated insight into the hypertrophic cardiomyopathies. For a better understanding of the disease, classification according to morphologic and functional criteria was introduced. It has proven useful to subdivide hypertrophic obstructive cardiomyopathy into two types: idiopathic hypertrophic subaortic stenosis and midventricular obstruction; hypertrophic nonobstructive cardiomyopathies can be subdivided into two forms designated as asymmetrical septal hypertrophy and apical hypertrophy. ⋯ Experience has shown that two-dimensional echocardiography, in particular, has assumed an especially important role, the value of which approaches that of cardiac catheterization. In this overview, emphasis is placed on the diagnostic peculiarities of idiopathic hypertrophic subaortic stenosis as well as the findings in midventricular obstruction and apical hypertrophy. In the past, only relatively little attention has been focused on the latter subgroups even though they can be diagnosed with a high degree of accuracy with noninvasive as well as invasive procedures.