From the Guidelines
Septal myectomy is a surgical procedure used to treat hypertrophic obstructive cardiomyopathy by removing part of the thickened heart muscle (septum) that separates the left and right ventricles, and it is considered the preferred treatment for most patients who meet specific clinical, anatomic, and hemodynamic criteria 1. The procedure begins with the patient under general anesthesia and connected to a heart-lung bypass machine.
- The surgeon makes an incision in the chest to access the heart, typically through a median sternotomy.
- After placing the patient on cardiopulmonary bypass and stopping the heart, the surgeon makes an incision in the aorta (transaortic approach) to access the left ventricle.
- The surgeon then carefully removes a portion of the thickened septal muscle, typically 3-10 mm in thickness and 30-50 mm in length, focusing on the area causing obstruction to blood flow. This resection extends from below the aortic valve to beyond the mitral valve contact point.
- In some cases, additional procedures may be performed simultaneously, such as mitral valve repair if there is significant mitral regurgitation. After ensuring adequate septal reduction and proper valve function,
- the aortic incision is closed,
- the heart is restarted, and
- the patient is weaned from bypass. The chest is then closed, and the patient is transferred to intensive care for recovery. This procedure effectively relieves left ventricular outflow tract obstruction, improves blood flow from the heart, and reduces symptoms such as shortness of breath, chest pain, and fainting in most patients with obstructive hypertrophic cardiomyopathy, as supported by the 2011 ACCF/AHA guideline for the diagnosis and treatment of hypertrophic cardiomyopathy 1.
From the Research
Steps of Septal Myectomy
The steps of septal myectomy are not explicitly described in the provided studies. However, the following information can be gathered:
- Septal myectomy is a surgical procedure used to treat obstructive hypertrophic cardiomyopathy [(2,3,4,5)].
- The goal of the procedure is to relieve left ventricular outflow tract obstruction and improve cardiac symptoms [(2,3)].
- The procedure involves removing a portion of the thickened septal wall to widen the left ventricular outflow tract 4.
- The technique used for septal myectomy may vary between institutions, but it is considered the gold standard treatment for obstructive hypertrophic cardiomyopathy [(2,4)].
Key Considerations
Some key considerations for septal myectomy include:
- Patient selection: proper patient selection is crucial for successful outcomes [(6,5)].
- Operative technique: the procedure requires a high level of surgical expertise and experience [(3,4)].
- Comparison with other treatments: septal myectomy is often compared with alcohol septal ablation, another treatment option for obstructive hypertrophic cardiomyopathy [(3,6,5)].
- Outcomes: studies have shown that septal myectomy can lead to significant improvements in symptoms and survival rates [(2,5)].