Historical and modern aspects of surgical treatment of hypertrophic cardiomyopathy in children (literature review)

Abstract

Hypertrophic cardiomyopathy (HCM) is a common, genetically determined myocardial pathology that can manifest itself at any age. The manifestation of this pathology in childhood always means a high risk of sudden cardiac death and the rapid progression of symptoms. The annual mortality in asymptomatic patients over 1 year is 1%. There are many recommendations for the management of patients with obstructive cardiomyopathy, but they are all written for the adult population. Drug treatment of symptomatic patients with this pathology is effective only in 70% of patients. The remaining 30% should be given preference to surgical treatment. It is important for a cardiac surgeon to know the main methods of HCM correction, their advantages and disadvantages. The literature review shows the evolution of methods of surgical correction of obstructive HCM from the middle of the 20th century until now. The main surgical methods for treating left ventricular outflow tract obstruction, correcting SAM-syndrome (systolic anterior motion syndrome) and mitral insufficiency, which have had a great influence on the development of HCM surgery, are presented. A clinical experience of treating left ventricular outflow tract obstruction in children is presented. The most promising method today is “transaortic extended septal myectomy”. Thus, there is a need to evaluate and modify existing methods for correcting obstructive HCM and their complications. Works aimed at their improvement and elimination of shortcomings are promising.