Related Experiment Video
Updated: Feb 22, 2026
Use of the Scissor-Type Knife During the Peroral Endoscopy Myotomy Procedure for the Treatment of Achalasia
Published on: March 3, 2023
Current state of the art and future of myectomy
Magdi H Yacoub1,2, Ahmed Afifi2, Hesham Saad2
1National Heart and Lung Institute, Imperial College London, London, UK.
Insights
Surgical relief of left ventricular outflow tract obstruction (LVOTO) in hypertrophic cardiomyopathy (HCM) is effective but requires a personalized approach. This gold standard treatment, though underused, offers predictable long-term outcomes with low risks.
Area of Science:
- Cardiovascular Surgery
- Cardiology
- Medical Imaging
Background:
- Hypertrophic cardiomyopathy (HCM) often causes symptomatic left ventricular outflow tract obstruction (LVOTO).
- Septal myectomy is the gold standard surgical treatment for symptomatic HCM patients without comorbidities.
- Effective LVOTO relief necessitates an individualized surgical strategy.
Purpose of the Study:
- To emphasize the comprehensive nature of surgical LVOTO relief in HCM.
- To highlight the importance of advanced imaging and tailored surgical techniques.
- To advocate for increased utilization of this effective treatment.
Main Methods:
- Preoperative multimodality imaging and numerical modeling to identify obstructive components.
- Intraoperative transesophageal echocardiography (TEE) to guide the procedure and assess repair adequacy.
- Individualized septal myectomy addressing fibrous trigones, accessory tissues, and papillary muscle anomalies.
Main Results:
- The mitral valve can be preserved in nearly all patients.
- The procedure demonstrates very low mortality and morbidity rates.
- Predictable good short-term and long-term outcomes are achievable.
Conclusions:
- Surgical LVOTO relief in HCM is a safe and effective procedure with excellent outcomes.
- A multidisciplinary approach utilizing advanced imaging is crucial for successful repair.
- Despite its benefits, surgical intervention for LVOTO in HCM remains significantly underutilized.
Abstract:
Surgical relief of left ventricular outflow tract obstruction (LVOTO) in hypertrophic cardiomyopathy (HCM) requires more than septal myectomy. The procedure is currently the gold standard for all symptomatic HCM patients except those with comorbidities. The operation requires an individualized approach to restore the sophisticated functions of the left ventricular outflow tract (LVOT) without injury to the surrounding vital structures. The procedure should be tailored to deal with all the varied components of the obstruction including fibrous trigones, accessory tissues, and papillary muscle fusion. Preoperative multimodality imaging and numerical modeling combined with intraoperative transesophageal echocardiography (TEE) are essential to define existing anomalies as well as assess the adequacy of the repair. The mitral valve can be conserved in virtually all patients. The operation can be conducted with very low mortality and morbidity with predictable good outcomes both in the short and long term. Nevertheless, surgical relief of LVOTO is still grossly underused.
