Transapical Approach to Septal Myectomy for Hypertrophic Cardiomyopathy

Area of Science:

• Cardiology
• Cardiovascular Surgery

Background:

• Apical hypertrophic cardiomyopathy (AHC) is a condition characterized by thickening of the heart muscle, potentially leading to diastolic dysfunction and heart failure.
• Management strategies for symptomatic AHC, particularly in the context of progressive heart failure, require careful consideration.

Observation:

• A literature review was conducted to determine the optimal management for a 63-year-old female with symptomatic AHC and diastolic dysfunction.
• The natural history of AHC suggests a benign prognosis, but watchful management carries risks of adverse cardiovascular events.

Findings:

• Transapical myectomy demonstrated low surgical risk and acceptable outcomes in the reviewed literature.
• In a specific case, transapical myectomy resulted in significant left ventricular cavity enlargement and improved cardiac function, with the patient discharged within 7 days.
• Post-operative assessment at 6 months showed the patient in NYHA Class I with enhanced exercise capacity.

Implications:

• Transapical myectomy can be considered a feasible and effective treatment for patients suffering from apical hypertrophic cardiomyopathy and advancing heart failure.
• This surgical approach may offer a valuable alternative to conservative management, improving quality of life and cardiovascular outcomes.