Anesthetic management of transapical beating-heart septal myectomy in a child with obstructive hypertrophic cardiomyopathy: a case report

Q: What is the clinical evidence from this study?

Study design: Case Report. Population: Obstructive hypertrophic cardiomyopathy (oHCM) (n=1). Intervention: Transapical beating-heart septal myectomy (TA-BSM).

Q: What does this research mean for the field?

Transapical beating-heart septal myectomy (TA-BSM) can be successfully performed in pediatric patients with obstructive hypertrophic cardiomyopathy, but requires meticulous hemodynamic management and multidisciplinary collaboration to manage severe perioperative complications such as cardiac arrest. Novelty: ClaimNovelty.NOVEL_FINDING. Consensus alignment: ConsensusAlignment.NEUTRAL.

Honghui Yu; Lin Cheng; Hongbo Zheng

doi:10.1186/s12871-026-03932-7

May 21, 2026BMC AnesthesiologyOpen Access

Anesthetic management of transapical beating-heart septal myectomy in a child with obstructive hypertrophic cardiomyopathy: a case report

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Key result

Transapical beating-heart septal myectomy cuts LVOT gradient ~94% in a pediatric obstructive HCM case.

n=1

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Why the study?

Data on transapical beating-heart septal myectomy in pediatric patients remain limited, and no cases had reported the anesthetic management for pediatric obstructive hypertrophic cardiomyopathy undergoing the procedure.

Key Points

To describe the anesthetic strategies, hemodynamic challenges, and emergency resuscitation required during transapical beating-heart septal myectomy in a pediatric patient with obstructive hypertrophic cardiomyopathy.
Treated a 9-year-old girl with obstructive hypertrophic cardiomyopathy (preoperative left ventricular outflow tract gradient of 101 mmHg) scheduled for transapical beating-heart septal myectomy under general anesthesia.
Implemented preoperative volume loading (≥1000 mL/day compound sodium chloride), mask induction with 5% to 8% sevoflurane, invasive arterial blood pressure monitoring, and ultrasound-guided serratus anterior plane block.
Maintained real-time transesophageal echocardiography monitoring alongside pharmacological hemodynamic control and primed standby cardiopulmonary bypass.
Beating-heart myectomy device manipulation induced frequent premature ventricular contractions, transient hypotension reaching 30/15 mmHg, and sudden ventricular fibrillation cardiac arrest during device rotation at the basal myocardium.
Immediate apical purse-string closure, direct open epicardial massage, electrical defibrillation at 56 J, and temporary pacing successfully restored cardiac function, resulting in a favorable recovery.

Study Design

Type

Case Report (n=1)

Multicenter

No

Structured PICO

P

Population

9-year-old girl with obstructive hypertrophic cardiomyopathy (oHCM), height 140 cm, weight 28 kg, with a preoperative left ventricular outflow tract gradient (LVOTG) of 101 mmHg and severe mitral regurgitation.

I

Intervention

Transapical beating-heart septal myectomy (TA-BSM) under general anesthesia with meticulous hemodynamic management and multidisciplinary collaboration.

O

Outcome

Relief of left ventricular outflow tract obstruction and successful completion of surgery.

Perioperative multidisciplinary collaboration and meticulous hemodynamic management are essential for the safe performance of transapical beating-heart septal myectomy in pediatric patients with obstructive hypertrophic cardiomyopathy.

Limitations

Only two years of follow-up in a single case, limiting generalizability and long-term assessment of conduction abnormalities.
Optimal ultrasound views during episodes of hemodynamic instability or immediately after resection were not saved.
Anesthetic strategy was largely adapted from adult experience, requiring further validation in pediatric patients.
Cannot definitively distinguish whether intraoperative cardiac arrest and conduction abnormalities were due to surgical manipulation, anesthesia, or anatomy.
Cannot establish causality between any specific anesthetic intervention and the clinical outcomes.
Only two years of follow-up in a single case
Optimal ultrasound views during episodes of hemodynamic instability or immediately after resection were not saved
Anesthetic strategy was largely adapted from adult experience, requiring further validation in pediatric patients
Cannot definitively distinguish whether the cardiac arrest, transient third-degree atrioventricular block, and new-onset complete left bundle branch block were attributable to surgical manipulation, anesthetic management, or the patient's own anatomical characteristics
Cannot establish causality between any specific anesthetic intervention and the clinical outcomes

Implication

Requires multidisciplinary perioperative management in pediatric obstructive HCM; extends adult TA-BSM data but leaves safety and efficacy open.

Abstract

Transapical beating‑heart septal myectomy (TA‑BSM) is considered an effective surgical approach for obstructive hypertrophic cardiomyopathy (oHCM). However, data regarding its application in pediatric patients remain limited. To date, no cases have been reported detailing the anesthetic management for pediatric oHCM patients undergoing TA‑BSM. We report the case of a 9‑year‑old girl with oHCM who underwent TA‑BSM under general anesthesia. Despite thorough preoperative preparation, she experienced significant perioperative complications, including hypotension and ventricular arrhythmias. Cardiac arrest occurred during rotation of the beating‑heart myectomy device (BMD) to adjust its angle. This critical event was successfully managed through direct epicardial compression, emergency temporary pacemaker implantation, and multidisciplinary collaboration, ultimately resulting in the patient’s favorable recovery. Pathology confirmed obstructive hypertrophic cardiomyopathy. Perioperative multidisciplinary collaboration and meticulous hemodynamic management are essential for the safe performance of TA‑BSM in pediatric patients with oHCM, offering guidance for similar cases.

Discussion

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Cite This Study

Yu et al. (2026) conducted a case report in Obstructive hypertrophic cardiomyopathy (oHCM) (n=1). Transapical beating-heart septal myectomy (TA-BSM) was evaluated. Transapical beating-heart septal myectomy successfully reduced the left ventricular outflow tract gradient from 66 mmHg to 4 mmHg in a 9-year-old girl with obstructive hypertrophic cardiomyopathy.

synapsesocial.com/papers/6a11475048a409a3a49e0501 https://doi.org/10.1186/s12871-026-03932-7

Topics

Hypertrophic cardiomyopathy

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Anesthetic management of transapical beating-heart septal myectomy in a child with obstructive hypertrophic cardiomyopathy: a case report

Figures

Key Points

Study Design

Structured PICO

Limitations

Implication

Abstract

Discussion

Cite This Study

Topics

Anesthetic management of transapical beating-heart septal myectomy in a child with obstructive hypertrophic cardiomyopathy: a case report

Figures

Key Points

Study Design

Structured PICO

Limitations

Implication

Abstract

Discussion

Cite This Study

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