3D Endoscopic Aortic Valve Replacement Combined With Extended Septal Myectomy via Right Lateral Minithoracotomy

Three dimensional (3D) endoscopic aortic valve replacement combined with extended septal myectomy (the Morrow procedure) via right lateral minithoracotomy offers a safe and effective single-stage surgical solution for the rare and hemodynamically complex coexistence of severe degenerative aortic stenosis (AS) and hypertrophic obstructive cardiomyopathy (HOCM) with critical left ventricular outflow tract (LVOT) obstruction.

The coexistence of severe degenerative (AS and HOCM with significant LVOT obstruction is an uncommon yet particularly demanding clinical and surgical scenario. Each condition independently imposes a substantial hemodynamic burden on the left ventricle; their concurrent presence creates compounding fixed and dynamic obstruction at the valvular level and in the subaortic region that accelerates functional deterioration and significantly limits conservative management options.

Isolated surgical aortic valve replacement (SAVR) may fail to adequately relieve LVOT obstruction if the underlying septal hypertrophy is not addressed. Conversely, septal myectomy alone does not correct valvular pathology. A combined single-stage approach is, therefore, preferable, yet the technical complexity of this procedure is amplified by the need for optimal myocardial protection, precise resection geometry, and preservation of the conduction system.

The authors report a case of combined 3D endoscopic biological aortic valve replacement and extended septal myectomy (the Morrow procedure) via right lateral minithoracotomy for severe degenerative AS with HOCM and critical LVOT obstruction.

Postoperative transthoracic echocardiography confirmed a well-functioning biological prosthesis with no significant transvalvular gradients, resolution of dynamic LVOT obstruction, and preserved biventricular systolic function. The patient was discharged in satisfactory condition. Extended follow-up is planned to assess prosthetic valve durability, atrial fibrillation (AF) burden under antiarrhythmic management, and long-term LVOT hemodynamics.

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