Surgical Treatment of Biventricular Outflow Tract Obstruction in Hypertrophic Cardiomyopathy

Objectives

Hypertrophic cardiomyopathy is usually associated with left ventricular outflow tract obstruction. It is rare to have a concomitant obstruction of the right ventricular outflow tract requiring resection. Patients with biventricular outflow tract obstruction tend to have more severe symptoms than patients with left ventricular outflow tract obstruction alone and non-obstructive hypertrophic cardiomyopathy. The authors present the successful surgical treatment performed for a child with the aforementioned diagnosis.

Methods

In this video, the authors demonstrate the successful surgical repair of biventricular outflow tract obstruction. The repair consisted of the traditional extended myectomy for the left ventricular outflow tract and patch augmentation of the right ventricular outflow tract.

Results

Postoperatively, the patient was extubated on postoperative day one, transferred to the step-down unit on postoperative day three, and eventually discharged on postoperative day 14. He developed atrial tachycardia postoperatively and was treated with sotalol. Follow-up at one month showed an asymptomatic patient with complete resolution of the biventricular outflow tract obstruction and normal systolic function by transthoracic echocardiography.

Conclusion

Surgical treatment of biventricular outflow tract obstruction by performing right-sided septal myectomy and patch augmentation of the right ventricular outflow tract in addition to the conventional left sided septal myectomy is feasible and can completely eliminate biventricular outflow tract obstruction.

This educational video was originally presented during the STSA 65th Annual Meeting. This content is published with the permission of the STSA. For more information on the STSA and its next Annual Meeting, please click here.