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Related Concept Videos

Mitral Regurgitation III: Medical Management01:25

Mitral Regurgitation III: Medical Management

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Mitral regurgitation (MR) is characterized by retrograde blood circulation from the left ventricle into the left atrium due to inadequate mitral valve closure. The severity of the condition, symptoms, and underlying cause determine treatment strategies.Monitoring and Pharmacological TreatmentPatients with mild to moderate MR typically do not need immediate intervention but regular monitoring to assess progression and guide treatment. Patients with mild MR should have an echocardiogram every 3-5...
686
Mitral Stenosis III: Medical Management01:26

Mitral Stenosis III: Medical Management

535
Mitral stenosis, a condition marked by the narrowing of the mitral valve, necessitates an integrated approach for effective management. This approach includes preventative measures, medical therapy, and surgical interventions to reduce symptoms and prevent complications.PreventionPrevention of mitral stenosis primarily focuses on reducing the incidence of bacterial infections, particularly streptococcal infections, which can lead to rheumatic fever and subsequent valvular damage. Timely...
535
Aortic Regurgitation III: Medical Management01:25

Aortic Regurgitation III: Medical Management

598
Aortic regurgitation (AR) is when the aortic valve does not close or seal properly, leading to backward blood circulation from the aorta into the left ventricle during diastole. Common causes of AR include rheumatic heart disease, congenital valve defects, and aortic root dilation. Managing AR requires a multifaceted approach to alleviate symptoms, preserve left ventricular function, and address the underlying cause of the regurgitation. Patients with symptomatic AR or significant left...
598
Cardiomyopathy III: Hypertrophic Cardiomyopathy01:29

Cardiomyopathy III: Hypertrophic Cardiomyopathy

805
Hypertrophic cardiomyopathy, or HCM, is an autosomal dominant genetic disorder characterized by asymmetric left ventricular hypertrophy without ventricular dilation. It is more common in men and is typically diagnosed in young, athletic adults.EtiologyHCM is primarily genetic and is caused by mutations in genes encoding sarcomeric proteins. Researchers have identified over 1400 mutations across at least 11 different genes. Among these, the most frequently occurring mutations are found in the...
805
Cardiomyopathy V: Interprofessional Care01:29

Cardiomyopathy V: Interprofessional Care

753
Managing cardiomyopathy involves addressing underlying or precipitating causes, treating heart failure with medications, and implementing dietary changes and a balanced exercise and rest regimen.Lifestyle ModificationsCardiomyopathy patients should adopt a low-sodium diet to reduce fluid retention and manage heart failure. A personalized exercise and rest plan helps maintain physical fitness without overstraining the heart. Avoiding alcohol and tobacco is essential to prevent further damage to...
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Cardiomyopathy VII: Pre and Post Operative Nursing Management01:28

Cardiomyopathy VII: Pre and Post Operative Nursing Management

460
Patients with hypertrophic cardiomyopathy (HCM) and left ventricular outflow tract (LVOT) obstruction who remain symptomatic despite optimal medical therapy may undergo a septal myectomy (Morrow procedure). This procedure involves excising a portion of the hypertrophied septum below the aortic valve using a heart-lung machine to improve blood flow through the LVOT. Effective preoperative and postoperative nursing management ensures successful patient outcomes, minimizes complications, and...
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Related Experiment Video

Updated: May 4, 2026

Minimally Invasive Transverse Aortic Constriction in Mice
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Transcatheter Myotomy to Reduce Left Ventricular Outflow Obstruction.

Adam B Greenbaum1, Hiroki A Ueyama2, Patrick T Gleason2

  • 1Structural Heart and Valve Center, Emory University Hospital, Atlanta, Georgia, USA. Electronic address: https://twitter.com/AdamGreenbaumMD.

Journal of the American College of Cardiology
|March 12, 2024
PubMed
Summary

A novel transcatheter electrosurgical procedure, septal scoring along midline endocardium (SESAME), effectively treated left ventricular outflow tract (LVOT) obstruction in hypertrophic cardiomyopathy and facilitated valve replacement procedures with high survival rates.

Keywords:
SESAMEhypertrophic cardiomyopathymyosin inhibitorsseptal reduction therapysuicide left ventricletranscatheter electrosurgerytranscatheter mitral valve replacement

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Area of Science:

  • Cardiovascular Medicine
  • Interventional Cardiology
  • Cardiac Surgery

Background:

  • Left ventricular outflow tract (LVOT) obstruction is a significant complication in hypertrophic cardiomyopathy (HCM) and following transcatheter aortic valve replacement (TAVR) and transcatheter mitral valve replacement (TMVR).
  • Current treatment options are limited by high risks and complications such as heart block requiring permanent pacemakers.

Purpose of the Study:

  • To evaluate the initial experience of a novel transcatheter electrosurgical technique, septal scoring along midline endocardium (SESAME), designed to mimic surgical myotomy.
  • To assess the safety and efficacy of SESAME in patients with symptomatic LVOT obstruction or those requiring facilitation of TMVR/TAVR.

Main Methods:

  • A single-center retrospective study of 76 patients undergoing SESAME between 2021 and 2023.
  • SESAME was used to treat 11 patients with HCM and 65 patients to facilitate TMVR or TAVR.
  • Myocardial laceration was performed using SESAME, and outcomes including LVOT dimensions, gradients, and procedural complications were analyzed.

Main Results:

  • All SESAME procedures were technically successful, with significant improvements in LVOT dimensions for patients undergoing valve replacement.
  • In HCM patients, SESAME led to a significant reduction in resting LVOT gradients.
  • The procedure demonstrated a high survival rate (97.4%), with low rates of serious complications like ventricular septal defects and free wall perforations. Permanent pacemaker implantation was infrequent.

Conclusions:

  • SESAME is a promising transcatheter technique for managing LVOT obstruction in both HCM and post-valve replacement scenarios.
  • The procedure can effectively reduce LVOT gradients and facilitate transcatheter valve implantation.
  • Further experience with SESAME may establish it as a valuable therapeutic option for specific patient populations.