In recent years, I have come into contact with many patients with hypertrophic obstructive cardiomyopathy, both in clinical practice and during internet consultations. Because this disease is not as widely carried out as conventional valve surgery, many patients receive more contradictory or outdated information, biased judgment of the disease, overestimation of surgical risks, and this disease is a disease with a very high risk of sudden death, and the consequences of delayed treatment are very serious, so I would like to make a distillation and answer to the common questions of patients in the clinic, hoping to save some That’s the purpose of this article. Q: I am asymptomatic or my symptoms are not severe, can I wait a few more years for surgery? A: Fear of surgery is a common problem for patients. The typical symptom is chest tightness and shortness of breath and palpitations after activity. If the patient is completely asymptomatic, our surgical indication would require a higher differential pressure, greater than 75 mmHg, before surgery; if the patient is symptomatic, a differential pressure greater than 50 mmHg should be operated. One of the biggest risks of hypertrophic obstructive cardiomyopathy is sudden death, with 15% of patients dying within 5 years after the onset of symptoms. Therefore, if your doctor tells you that you should have surgery, please do it as soon as possible, as you only live once. Of course, after fully understanding the above information, if you still choose conservative treatment is certainly possible, everyone has the right to give up treatment, but please think of your loved ones and your loved ones! Q: The heart ultrasound was done and my differential pressure is not large, less than 50mmHg, do I need surgery? A: Whether or not to operate in this case should be analyzed specifically. Hypertrophic cardiomyopathy can be divided into three categories according to whether it obstructs the left ventricular outflow tract: obstructive, non-obstructive, and power obstructive (or occult). Patients with power obstruction can have a very small differential pressure at rest, only a dozen mmHg, or even a few mmHg in some cases, while the differential pressure can rise significantly after exercise. I once had a patient with an echocardial pressure differential of only 12 mmHg, and the differential pressure still did not change significantly after activity. The patient reported significant chest tightness and shortness of breath after climbing a building, so I gave her an echocardial examination with intravenous isoprenaline, and as a result, the patient’s left ventricular outflow tract pressure differential gradually increased to 64 mmHg as the drug dose increased, and the patient obviously felt discomfort, and after stopping the drug, the echocardial After stopping the drug, the differential pressure gradually decreased again. The patient then underwent surgery, which was very successful. Of course, if the patient has a small differential pressure and is completely asymptomatic, there is no need to perform such a test, as long as the outpatient review of the echocardiogram is done once a year. Q: Is there an ablation method in internal medicine that can be done without surgery, and is it better than surgery? Or can I have ablation first and then have surgery if it is not good? A: I do not recommend this. Surgery is the gold standard for the treatment of this disease, and the gold standard means the highest success rate, the best outcome, and most importantly, the lowest mortality rate. The literature reports that the mortality rate of surgical procedures is less than 1% in experienced centers, and my cardiac surgery department at Ruijin Hospital has been successful in recent years. The principle of internal ablation is to artificially cause myocardial infarction in the coronary arteries of the septum and make the myocardium thinner, the effect is much worse, the mortality rate is half to double, and the complications are 4-5 times higher. I attended some domestic conferences where some leading cardiologists no longer do ablation because they feel that the effect of the procedure is uncertain and, most critically, that patients who have undergone medical ablation and then go for surgery have a greatly increased risk of cutting through the septum and having to install a pacemaker for conduction block. Therefore, I recommend that patients go directly to surgery. Only those patients who are not suitable for surgery can try medical ablation. Q: I have mitral valve insufficiency, should I have mitral valve replacement at the same time as surgery or not? A: In most cases, it is not necessary. In hypertrophic obstructive cardiomyopathy, mitral valve insufficiency improves significantly after adequate excision of the hypertrophic muscle and free release of the papillary muscle. However, there are some patients who have lesions on the mitral valve itself and require mitral valve repair surgery. Mitral valve replacement is appropriate for patients who have severe problems with the mitral valve that cannot be shaped and for patients with very severe diffuse obstruction and small ventricular chambers. At experienced centers, the chances of mitral valve replacement are greatly reduced. Q: How risky is this procedure? A: As mentioned earlier, in experienced centers, the operative mortality rate is less than 1%. To be more specific, the cardiac surgery department of Ruijin Hospital, where I work, performs about 50 cases of enlarged Morrow surgery every year, and all of them have been successful in the last three or four years. Beijing Fu Wai Hospital and Anzhen Hospital also perform dozens to hundreds of surgeries per year and report excellent outcomes. In the case of inexperienced centers, the risk increases significantly. Q: What are the long-term results after surgery? Will there be recurrence? A: The results of the surgery are excellent, and the survival curve of patients after surgery is similar to that of the normal population, that is, their lives are not shortened. The available literature reports essentially no recurrence.