An innovative minimally invasive approach for hypertrophic obstructive cardiomyopathy: Transaortic septal myectomy via right infra-axillary incision

Figures

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  Surgical septal myectomy via a right infra-axillary incision.

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  Figure 1. A, Preoperatively mark intercostal spaces; the patient shown is supine with a right anterior oblique of 30°. B, Enter the thoracic cavity through the third intercostal space on the lateral side of the pectoralis major muscle. C, Open the pericardium to expose the ascending aorta and heart. D, Expose the left ventricular outflow tract and anterior leaflet of the mitral valve through the aortic incision. E, Shown is the scar under right infra-axillary. Right: Partially surgically resected tissue.

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  Figure 2. The top 2 images are the preoperative transesophageal echocardiogram and the bottom 2 images are postoperative.

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  Figure 3. The red arrow in A shows the view from the right axillary to left ventricular apex perspective, the interventricular septum (red arrow in B) appears as a triangular blanket spread above the surgical field.

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  Figure 4. A, Secondary chordae resection. B, Plication of anterior mitral leaflet. C, Apical-basal muscle bundle resection. D, Postoperative left ventricular outflow tract.

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  Figure E1. A portion of extended-length minimally invasive cardiovascular surgical instruments we used.