Trans-Septal Approach for Hypertrophic Obstructive Cardiomyopathy

Area of Science:

• Cardiology
• Cardiac Surgery

Background:

• Hypertrophic obstructive cardiomyopathy (HOCM) is a genetic heart muscle disease characterized by septal hypertrophy, leading to left ventricular outflow tract (LVOT) obstruction and mitral regurgitation (MR).
• Transaortic septal myectomy, or Morrow's procedure, is the gold standard surgical treatment for symptomatic HOCM.

Observation:

• A 58-year-old male with recurrent syncope due to HOCM underwent septal myectomy.
• Intraoperative palpation suggested Morrow's procedure alone would be insufficient to relieve MR and systolic anterior motion (SAM) of the mitral valve.

Findings:

• A modified surgical approach involving incision of the right ventricular outflow tract and ventricular septum allowed for direct visualization and resection of residual hypertrophied septum.
• Postoperative echocardiography confirmed significant improvement in MR and LVOT obstruction.
• The patient's medical therapy was de-escalated post-surgery.

Implications:

• A trans-septal approach is a viable alternative when Morrow's procedure provides inadequate septal resection for HOCM.
• This modified technique can effectively resolve LVOT obstruction and associated MR, improving patient outcomes.
• Direct visualization during surgery is crucial for optimizing septal resection in complex HOCM cases.