Use of Intraoperative Dobutamine Stress Echocardiography on Outcomes of Septal Myectomy

Septal myectomy is the standard treatment for obstructive hypertrophic cardiomyopathy. We studied the impact of intraoperative pre- and postprocedure dobutamine stress transesophageal echocardiography on surgical planning and outcomes of septal myectomy. We identified 55 patients undergoing septal myectomy over a 24-month period. All patients underwent resting and dobutamine stress (20–40 mcg/kg/min) echocardiography after induction of anesthesia pre- and postprocedure. Demographic, clinical, and imaging data were prospectively collected. Mean age was 59 (42–68). A total of 69% of patients were New York Heart Association Class III/IV. During outpatient evaluation, peak preoperative resting left ventricular outflow tract gradient was 91.6 mm Hg and 94% (50/53) had severe stress-induced mitral regurgitation (MR). After induction, peak resting gradient fell to 47.8 mm Hg and 43% (24/55) had improved gradients (