Phil B.FontanarosaMD, Interim CoeditorIndividualAuthorMargaret A.WinkerMD, Deputy EditorIndividualAuthorStephenLurieMD PhD, Fishbein FellowIndividualAuthor
To the Editor: We feel compelled to object
to much of the content of the article on hypertrophic cardiomyopathy (HCM)
by Dr Fananapazir,1 published as a Grand
Rounds from the National Institutes of Health.
First, the ventricular septal myotomy-myectomy operation is at present
the treatment of choice for patients with severe outflow obstruction and disabling
symptoms refractory to drug treatment. At experienced centers, surgery has
proved (for more than 40 years) to be highly successful in relieving obstruction
and symptoms on a long-term basis and has an operative mortality that is now
low (≤1%-2%).2 Indeed, some surgeons
have reported virtually no operative mortality in more recent years.3 Therefore, the statement by Fananapazir that "these
are major operations with significant mortality and morbidity" is misleading.
Readers should be aware that surgery remains an important option for severely
symptomatic patients with obstructive HCM.
Maron BJ, McKenna WJ, Elliott P, Spirito P, Frenneaux MP, Keren A, Cecchi F, Borggrefe M, Williams WG. Hypertrophic Cardiomyopathy. JAMA. 1999;282(24):2302-2303. doi:10-1001/pubs.JAMA-ISSN-0098-7484-282-24-jbk1222