Does transapical septal myectomy improve hemodynamics and symptoms in a patient with hypertrophic cardiomyopathy and residual midventricular obstruction after alcohol septal ablation?
Transapical septal myectomy is an effective surgical approach for correcting residual midventricular obstruction in hypertrophic cardiomyopathy when transaortic access is precluded by distal hypertrophy or post-ablation scarring.
The aim of this publication is to evaluate the efficacy and safety of transapical septal myectomy for surgical correction of residual midventricular obstruction of the left ventricular outflow tract in a patient with hypertrophic cardiomyopathy in 2 years after alcohol septal ablation (ASA). Transapical septal myectomy, myocardial revascularization and left ventriculoplasty were performed under cardiopulmonary bypass and cardioplegia. Postoperatively, positive dynamics were noted with complete regression of chronic heart failure symptoms. Early postoperative period was uneventful. A follow-up echocardiography demonstrated normalization of intracardiac hemodynamics with elimination of pressure gradient and improvement of left ventricular diastolic function. If transaortic access is impossible due to distal hypertrophy or post-ASA scarring, transapical access to the apical and middle segments of the interventricular septum is essential.
Ermetov et al. (Wed,) studied this question.