3D-technology in hypertrophic cardiomyopathy surgery
RSPC "Cardiology" — one of the world leaders in radical surgical treatment of hypertrophic cardiomyopathy
Since the end of 2007 surgical treatment of a difficult, genetically determined cardiac pathology – hypertrophic cardiomyopathy – has been actively developing in the Republic of Belarus. Due to thickening of the muscular septum between the heart chambers, its cavities significantly decrease, and therefore, the useful volume of the blood, ejected into the systemic blood flow, also decreases. In addition, due to hypertrophy there is an obstruction to the free blood flow from the heart, which eventually inevitably leads to specific complaints (shortness of breath with light exercise, dizziness, fainting, heart rhythm disturbances) and clinical manifestations of heart failure. Quite often the disease is asymptomatic. However, the insidiousness of hypertrophic cardiomyopathy is that its first, and sometimes its only manifestation can be sudden cardiac death.
The main method of treatment of this disease with blood flow obstruction in the left ventricle, according to the world recommendations, is surgery — myoseptectomy, i.e. excision (removal) of excess tissue of hypertrophic interventricular septum. It is performed to eliminate the obstruction of the heart and increase the usable filling volume of its main pumping chamber — the left ventricle.
This method of treatment is the most effective in terms of early results and long-term survival prognosis, it is most common in the USA, the Russian Federation, China and some Central European countries.
In RSPC "Cardiology" preparation and performance of surgeries in patients with hypertrophic cardiomyopathy is conducted by the initiative group under the leadership of the cardiac surgeon of the highest category, PhD, leading specialist of the Heart Surgery Laboratory Vladimir Andruschuk (general management, main operator), which also includes: cardiac surgeons — Vitaly Odintsov (PhD, operator, assistant, management of patients in the perioperative period and observation period), Artem Nevyglas (computer 3D modeling, conducting "virtual" operation); high-class specialists of ultrasonic diagnostics department — Tatiana Sevruk (Head of the Department), Iraida Ustinova, Svetlana Kurganovich, specialists of X-ray department — Tatiana Ilyina, Anna Model, Irina Gaidel.
In 2016–2017 the initiative group developed and effectively applied an original innovative method of surgical treatment of an obstructive form of hypertrophic cardiomyopathy — 3D-modelled myoseptectomy. Based on modern methods of examination (magnetic resonance or computed tomography of the heart, echocardiography) an anatomically individualized 3D model of the heart (interventricular septum) is created for each particular patient and a "virtual" (computer) myoseptectomy is performed to achieve the best results. Then a plastic model of the "ideal" interventricular septum and its excess fragment to be removed is printed on a 3D printer. 3D models are sterilized and used by a cardiac surgeon during a real heart surgery as a visual plan of the surgery and a kind of quality control of its performance.
The developed method allows performing surgeries according to an individual plan and achieving maximal radicality of intervention. During the first three years of application of the new technique the specialists of the Center managed to achieve impressive results and make a colossal breakthrough: radically performed myoseptectomy allowed to greatly reduce significant concomitant mitral valve insufficiency in all patients, save own valve without its prosthetics, and also to obtain optimal results of heart obstruction treatment without a single case of hospital mortality. Today, the cardiac surgeons of RSPC "Cardiology" are the acknowledged leaders by the weight and volume of the dissected hypertrophic myocardium of the heart and radicality of the intervention. They have described the most radical dissections of interventricular septum in the world scientific literature.
The technology of 3D modeling of the heart in hypertrophic cardiomyopathy has won well-deserved recognition among colleagues from leading clinics in Europe. The successes of the cardiac surgeons of our Center have not gone unnoticed: our specialists were invited to present scientific reports at the world leading scientific forums in Milan (Italy, 2018), St. Petersburg and Moscow (Russia, 2018-2019), as well as lectures in Hanover (Germany, 2017) and Bialystok (Poland, 2019). Scientific works of the specialists of the Center on these topics in 2018–2019 were published in prestigious world scientific journals on cardiac surgery.
Leading cardiac surgeons from world-renowned clinics of Germany (Hannover Medical School, Hannover http://www.medvestnik.by/ru/officially/view/belorusskij-generator-nemetskoj-tochnosti-17432-2018/) and Great Britain (Royal Brompton Hospital & Harefield Hospital, London http://www.medvestnik.by/ru/news/view/anglijskij-kardiointeres-19133-2019/), as well as from neighboring Ukraine and Russia have already come to RSPC "Cardiology" to learn and adopt the innovative experience of surgical treatment of obstructive hypertrophic cardiomyopathy. Recently, Italian, Polish, Romanian, Slovenian and Kazakh cardiac surgeons have been actively interested in our experience.
Success of the specialists of the RSPC "Cardiology" in treatment of hypertrophic cardiomyopathy resulted in the annual increase in the number of operated patients, which currently amounts to 40 patients per year. Our Center has become one of the world leaders in the number of operations for this pathology per one million population. As of the end of 2022, we have experience in the surgical treatment of more than 200 patients with obstructive hypertrophic cardiomyopathy. Among our patients there are not only Belarusians, but also citizens of foreign countries who purposefully came to Belarus, to our Center for surgical treatment on a paid basis, and were successfully operated on.
