[Mitral valve replacement for heart failure due to hypertrophic obstructive cardiomyopathy; report of a case].

Myotomy or myectomy are well known as the standard treatment of hypertrophic obstructive cardiomyopathy (HOCM), and mitral valve replacement (MVR) is reported to achieve the equivalent therapeutic effect. And recently, combined treatment with artificial chordae replacement and MVR has been reported to improve the prognosis. We herein describe a case of a patient with HOCM who developed acute exacerbation of heart failure. The patient was 74-year-old woman, who had been followed by chronic atrial fibrillation (Af) and HOCM for 3 years. The findings at echocardiography included septal hypertrophy, systolic anterior motion (SAM) of the mitral valve, severe stenosis of left ventricular outflow tract (LVOT), and severe mitral valve regurgitation (MR). Calcification of mitral valve was also found. After the medical management, the patient was treated successfully by MVR using a mechanical valve combined with artificial chordae replacement. Maze procedure was also performed for chronic Af. The postoperative course was uneventful. MVR combined with artificial chordae replacement could be one of the useful strategies for HOCM associated with severe MR and organic changes of mitral valve.