septal myectomy


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septal myectomy

Surgical removal of hypertrophied cardiac muscle from the ventricular septum of patients with obstructive hypertrophic cardiomyopathy whose symptoms of heart failure are not well managed with medication alone.
References in periodicals archive ?
Background: Percutaneous transluminal septal myocardial ablation (PTSMA) and modified Morrow septal myectomy (MMSM) are two invasive strategies used to relieve obstruction in patients with hypertrophic cardiomyopathy (HCM).
If a patient has both conditions, surgical aortic valve replacement (SAVR) with septal myectomy or, alternatively, alcohol septal ablation (ASA) followed by transcatheter aortic valve implantation (TAVI) should be considered [2, 3].
Currently, the standard of treatment for HOCM, aside from managing cardiac risks, is septal myectomy [14].
All of the patients were receiving beta-blocker treatment, and one subject had undergone septal myectomy.
(1) Morrow and colleagues successfully relieved the obstruction first by ventricular septal myotomy (7) and later, by septal myectomy. (8) Angiocardiographers (9,10) and then echocardiographers11 described the location of obstruction in hypertrophic cardiomyopathy as the site of apposition of the edge of the anterior mitral leaflet to the hypertrophied ventricular septum during systole, the result of systolic anterior motion of the anterior leaflet.
Obstructed patients, who fail medical therapy, are usually offered invasive treatment: surgical septal myectomy, alcohol septal ablation, or DDD pacemaker.
After consultations with specialists in structural heart disease and cardiothoracic surgery, the patient ultimately underwent cardiac surgery consisting of very gentle septal myectomy focusing more midventricular at the basilar septum, reorientation of the posterior medial papillary muscle head, resection of the tethering secondary chordae to the A1 segment of the mitral valve, and chordal shortening and tacking of the chordae to the A1 and A2 segments of the mitral valve.
For the typical HCM patient with drug-refractory symptoms, surgery with septal myectomy is the first-line therapeutic approach [20, 21].
Objective: The surgical management of left ventricular outflow tract (LVOT) obstruction secondary to hypertrophic cardiomyopathy (HCM) has classically consisted of a septal myectomy. To address inconsistent results the extended myectomy or resection (R) and papillary muscle release (R) have been described.
Patients with persistent symptoms after medical therapy with a left ventricular outflow tract (LVOT) gradient of >50 mm Hg are referred for septal myectomy. A review of both early and recent literature of outcomes of surgical therapy was performed.