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[Hypertrophic Obstructive Cardiomyopathy Associated with Apical-basal Muscle Bundle Treated by Extended Septal

Takayuki Abe1, Kouan Orii, Taichi Kondou

  • 1Department of Cardiac Surgery, Saitama Prefectural Circulator and Disease of the Respiratory Organ Center, Kumagaya, Japan.

Kyobu Geka. the Japanese Journal of Thoracic Surgery
|September 25, 2025
PubMed

Insights

Obstructive hypertrophic cardiomyopathy in a 74-year-old woman was treated with extended septal myectomy. Accurate diagnosis of the apical-basal muscle bundle causing left ventricular outflow tract obstruction avoided unnecessary mitral valve surgery.

Area of Science:

  • Cardiology
  • Cardiac Surgery
  • Medical Imaging

Background:

  • Obstructive hypertrophic cardiomyopathy (oHCM) presents with left ventricular outflow tract (LVOT) obstruction.
  • Apical-basal muscle bundles can contribute to LVOT obstruction in oHCM.
  • Symptoms may include heart failure and mitral regurgitation.

Purpose of the Study:

  • To describe the surgical management of oHCM with LVOT obstruction due to an apical-basal muscle bundle.
  • To evaluate the diagnostic accuracy and treatment outcomes.

Main Methods:

  • Transthoracic echocardiography and other imaging modalities for diagnosis.
  • Surgical intervention including extended septal myectomy.
  • Intraoperative transesophageal echocardiography to assess mitral valve function and systolic anterior motion.

Main Results:

  • Preoperative peak LVOT velocity of 6.1 m/s during Valsalva maneuver and moderate mitral regurgitation.
  • Successful exclusion of the apical-basal muscle bundle (6 mm diameter).
  • Postoperative peak LVOT velocity improved to 2.5 m/s with no detected mitral regurgitation.

Conclusions:

  • Accurate diagnosis and targeted surgical intervention (extended septal myectomy) effectively treated oHCM with LVOT obstruction.
  • Valvular surgery was successfully avoided.
  • This approach offers a viable treatment strategy for complex oHCM cases.

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