Transapical Myectomy for Septal Hypertrophy Not Accessible Through the Aortic Root

Exposure of the basal and midventricular septum through the aortic root to relieve obstruction in hypertrophic cardiomyopathy can be challenging. Inadequate myectomy will lead to persistent symptoms and disability. Adequate exposure of the obstructive left ventricular septum is of paramount importance in primary and redo myectomy. In selected patients, either at primary myectomy or at redo myectomy, septal excision can be approached through a left ventricular transapical incision when transaortic exposure is inadequate.