Hypertrophic Obstructive Cardiomyopathy: Anatomical Substratum for Tailored Surgical Correction

Hypertrophic obstructive cardiomyopathy is a heterogeneous cardiac disease with a complex anatomical substratum. Surgery is fundamental not only in bringing symptoms relief, but also survival benefit. In experienced centers, surgery can be low risk and deliver excellent outcomes. To do so, many anatomical components must be investigated with meticulous imaging to develop a tailored surgical plan for each patient. In fact, the left ventricular outflow tract obstruction results from a deep and complex interaction between the interventricular septum and the mitral valve abnormal apparatus, in terms of papillary muscles, chords, and leaflets abnormalities. As a consequence, myectomy is not sufficient to treat this pathology, but all other targets need to be addressed surgically to obtain a good and durable result. 

Surgery in these patients does not mean only performing an extended septal myectomy, but also freeing the papillary muscle by cutting the excessive secondary chordae, and in some cases, also treating the mitral leaflets, with a different combination every time. This video explains, with accurate imaging, all these surgical steps with detailed examples to highlight all the targets and pitfalls in the surgical treatment of these patients.

References

1. Hang D, Nguyen A, Schaff HV. Surgical treatment for hypertrophic cardiomyopathy: a historical perspective. Ann Cardiothorac Surg. 2017;6(4):318-328. doi: 10.21037/acs.2017.04.03
2. Ralph-Edwards A, Vanderlaan RD, Bajona P. Transaortic septal myectomy: techniques and pitfalls. Ann Cardiothorac Surg. 2017;6(4):410-415. doi: 10.21037/acs.2017.07.08
3. Ommen et al, Long-Term Effects of Surgical Septal Myectomy on Survival in Patients With Obstructive Hypertrophic Cardiomyopathy. JACC .Vol. 46, No. 3, 2005. ISSN 0735-1097/05/$30.00 doi:10.1016/j.jacc.2005.02.090

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