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Crowding of the left ventricular outflow tract by prominent papillary muscle

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silkee27 Male, Age 58, born in Norwalk CT. Living in Scottsdale AZ with wife Barbara and doggies Snowy (West Highland Terrier) and Saint Bernard (Jarvis) Find out more about silkee27
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  • Crowding of the left ventricular outflow tract by prominent papillary muscle

    May-2016: Diagnosed with HCM with Obstruction at MAYO/Scottsdale-Phoenix, Symptoms Chest Pain, Shortness of Breath
    AUG-2016: Septal Myectomy, MAYO/Rochester Chest Pain & Shortness of Breath ... Stopped
    SEP-2016 thru DEC-2016: Feinted 2x, Dizzy spells 15+ times where I felt if I did not stop, hold onto wall or sit down I could feint.
    Activities causing Dizzy spells: Bending down to Pet dog, standing up ... Dizzy. Walk up 1 flight of Stairs ... Dizzy, Get off City Bus ... Dizzy
    Note: Never 1x had Dizzy Spell before Septal Myectomy
    Dec-2016: Implant of dual-chamber Cardioverter defibrillator, MAYO/Scottsdale-Phoenix
    Note: Feinting / Dizzy Spells stopped. Last reading, MAR-2017 paced 6% of time
    ECHO, MAR-2017, Mayo/Scottsdale-Phoenix:
    Hypertrophic Cardiomyopathy. Status post extended left ventricular septal myectomy (10AUG).
    The Maximum wall thickness noted in the basal to mid septum (18 mm).
    No systolic anterior motion of the mitral valve but there is crowding of the left ventricular outflow tract by prominent papillary muscle. This results in a mid left ventricular provoked
    (strain phase of the Valsalva maneuver) peak systolic maximum instantaneous gradient of 46 mmHg. There is no significant gradient at rest. Mild Mitral Valve Regurgitation.

    Question1: What is an average gradient of a Healthy NON-HCM heart during (strain phase of the Valsalva maneuver)? There is no significant gradient at rest but at peak 46. Am I at risk during physical exercise?
    Question2: With the feinting & dizzy spells post Septal Myectomy + crowding of the left ventricular outflow tract by prominent papillary muscle ... am I a candidate for Papillary resection? Did the implant relieve symptoms but not the root cause? Current Symptom: Extreme fatigue, most days
    Last edited by silkee27; 07-16-2017, 10:02 AM.

  • #2
    Hi Silkee,
    Sorry you're going through this!

    A completely normal heart will have a gradient near zero. And while there's no specific line that says that below this value, that's close to zero, and above, it's not, a gradient of 46 isn't close to zero.

    Here's what I think: when you went to Mayo in Rochester, you saw one of the HCM specialists there, right? Why don't you send them this echo report and ask what they think? The fact that you're not having symptoms any longer is key, I think -- nobody wants to do surgery on someone who's doing OK without it! But it does seem to me that you want to be working with an HCM specialist.

    Gordon
    Myectomy on Feb. 5, 2007.

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    • #3
      Thank You for the advise to follow-up with HCM team at Rochester, MN who performed my Septal Myectomy(AUG-16).
      It does make me wonder why my Pre-Myectomy ECHO: Anteriorly displaced, thick papillary muscle with short chordal attachments was not treated during the Septal Myectomy.

      Question: With gradient increase from 0 Rest to 46 mmHg (strain phase of the Valsalva maneuver), is one at risk during physical exertion? thankU

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      • #4
        Do you feel symptomatic? I'm guessing not, since you said the ICD had resolved your symptoms. My instinct is to say that if you follow the usual guidelines for exercise for HCM patients, you're probably fine.

        Gordon
        Myectomy on Feb. 5, 2007.

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