Related Experiment Video
Updated: Apr 21, 2026
Operating Transverse Aortic Constriction with Absorbable Suture to Obtain Transient Myocardial Hypertrophy
Published on: September 9, 2020
A case of mid-apical obstructive hypertrophic cardiomyopathy treated with a transapical myectomy approach: a case
Thiago Luis Scudeler, Paulo Cury Rezende, Fernando Teiichi Costa Oikawa
1Department of Atherosclerosis, Heart Institute (InCor), University of São Paulo, Avenida Doutor Enéas de Carvalho Aguiar 44, AB, Sala 114, Cerqueira César, 05403-000 São Paulo, SP, Brazil. whady.hueb@incor.usp.br.
Insights
Transapical myectomy offers a new surgical option for mid-apical obstructive hypertrophic cardiomyopathy. This approach effectively resolved symptoms in a patient refractory to medical treatment.
Area of Science:
- Cardiology
- Cardiac Surgery
- Genetics
Background:
- Hypertrophic cardiomyopathy (HCM) is a genetic heart condition with variable presentation.
- Myocardial hypertrophy can affect different parts of the left ventricle, including mid-apical segments.
- Standard treatments include medical therapy, with surgery reserved for specific cases.
Observation:
- A 63-year-old woman with symptomatic mid-apical obstructive hypertrophic cardiomyopathy despite optimal medical therapy.
- Transthoracic echocardiography and cardiac MRI confirmed significant left ventricular hypertrophy in the mid-apical region.
- A transaortic approach was deemed difficult, prompting consideration of an alternative surgical strategy.
Findings:
- A successful transapical myectomy was performed for mid-apical obstructive hypertrophic cardiomyopathy.
- The patient experienced complete resolution of symptoms post-procedure.
- No complications were reported following the transapical approach.
Implications:
- Transapical myectomy is a viable and effective treatment for mid-apical obstructive hypertrophic cardiomyopathy.
- This approach should be considered for patients with refractory symptoms.
- Further research into the transapical approach for HCM is warranted.
Introduction:
Hypertrophic cardiomyopathy is a genetic cardiac disease characterized by marked variability in morphological expression and natural history. The hypertrophic myocardium is often confined to the septum or lateral wall of the left ventricle, but it can also be encountered in the middle or apical segments of the myocardium. Treatment is based on medical therapy. Others therapies, such as embolization of the septal artery or ventriculomyectomy, are indicated in special situations. Surgery is the standard treatment, and it is classically done via a transaortic approach; however, in cases in which the hypertrophic myocardium is confined to mid-apical segments, a transapical approach is an option. Only a few cases of mid-apical obstructive hypertrophic cardiomyopathy treated with a myectomy using a transapical approach have been reported in the English-language literature. In this report, we present a case of a patient with mid-apical obstructive hypertrophic cardiomyopathy treated using this new approach.
Case Presentation:
A 63-year-old Caucasian woman presented with a history of chest pain and shortness of breath causing significant limitations on her daily life activities. She had a history of coronary artery disease. Her physical examination was unremarkable. Transthoracic echocardiography revealed normal systolic function and significant concentric left ventricular hypertrophy that was greater in the mid-apical region. Nuclear magnetic resonance imaging confirmed significant hypertrophy of the median segments of the left ventricle. The patient had persistent symptoms despite receiving optimized medical treatment, and a surgical approach was indicated. As a myectomy using transaortic technique was thought to be difficult to perform in her case, a transapical approach was used. No complications occurred, and her symptoms resolved.
Conclusion:
A transapical myectomy should be taken into consideration for patients with mid-apical obstructive hypertrophic cardiomyopathy that is refractory to medical treatment.
More Related Videos
08:42Cox-Maze IV Procedure Concomitant with Valvular Surgery In Situs Inversus Dextrocardia: A Single-Center Experience in China
Published on: February 11, 2022
14:39Isolation and Functional Characterization of Human Ventricular Cardiomyocytes from Fresh Surgical Samples
Published on: April 21, 2014