Mitral valve replacement and right ventricular outflow repair for hypertrophic obstructive cardiomyopathy

A 44-year-old male with hypertrophic obstructive cardiomyopathy (HOCM) was operated on. He was in NYHA class III with a chief complaint of exertional dyspnea refractory to medical treatment. Echocardiography showed asymmetric septal hypertrophy and systolic anterior movement of the mitral valve, which caused obstruction of the left ventricular outflow tract. It also showed obstruction of the right ventricular outflow tract due to septal hypertrophy. Cardiac catheterization showed a systolic pressure gradient of 70 mmHg at the LV outflow tract and that of 30 mmHg at the RV outflow tract. He underwent mitral valve replacement and patch enlargement of the RV outflow tract. Postoperative course was uneventful. Postoperative catheterization showed a remarkable decrease of pressure gradient to 10 mmHg at the both outflow tracts.