What is septal myectomy?
Septal myectomy is an open-heart surgery to remove part of a thickened heart muscle, which is a condition called hypertrophic cardiomyopathy (HCM).
HCM is a type of heart disease associated with an uneven thickening of the heart muscle, most commonly at the membrane that separates the right and left sides of the heart (septum).
This thickening can cause a blockage of blood exiting from the heart (known as left ventricular outflow tract obstruction).
Your surgeon will remove a portion of the enlarged heart muscle allowing blood to move through your heart unrestricted.
Septal myectomy is the most effective and low-risk treatment for symptoms of HCM.
Why is this septal myectomy done?
If you have HCM and your symptoms haven’t improved with medications, your doctor may recommend this surgery.
Some recent studies have also suggested that this procedure may reduce the risk of sudden death associated with HCM.
Septal myectomy has a high success rate and a low risk of needing a pacemaker after the procedure.
When is a septal myectomy necessary?
If you have a severe thickening of the heart muscle, this procedure is necessary to improve blood flow through the heart.
Those who wish to become pregnant may need the surgery prior to becoming pregnant, even if symptoms are mild.
How to prepare for your septal myectomy
Prior to your surgery, you’ll meet with your doctor to discuss your medical history, the medicines you take and any questions you have.
Your doctor may tell you to stop taking certain medications, such as blood thinners, before the surgery.
If you smoke, you should try and stop before the operation.
You may have several tests to check your heart health, including:
- Blood tests
- Cardiac catheterization
- Cardiac MRI
- Chest X-rays
- Echocardiograms
- Electrocardiograms
How is a septal myectomy done?
You’ll be given general anesthesia to help you sleep and not feel any pain during the surgery.
Your surgeon will make an incision down the middle of your chest and separate your breastbone (sternum) to reach your heart.
You’ll be connected to a heart-lung machine (called a cardiopulmonary bypass) to take over the work of your heart and lungs. This allows doctors to work on your heart more easily and safely.
Your surgeon enters the heart through the aortic valve and cuts away a portion of the thickened muscle. This increases the space inside the left ventricle and removes the blockage restricting blood flow.
The surgeon will then tie together your breastbone and close all incisions. The surgery lasts about three to four hours.
Recovery from a septal myectomy
After your surgery, you are transferred to an intensive care unit for one to two days.
Your doctors and nurses closely monitor your heart, blood pressure, oxygen and vital signs.
This procedure usually requires you to stay in the hospital five to six days. Many patients are able to go back to work in as little as six weeks.
What are the risks of a septal myectomy?
This procedure is a relatively safe and effective way to treat HCM. However, every surgery has risks and the possibility of complications, including:
- Aortic valve problems
- Atrial fibrillation
- Fluid around your heart or lungs
- Heart blocks that lead to arrhythmia
- Bleeding
- Infection
What are the benefits of a septal myectomy?
By treating HCM through this surgery, you’ll be free from symptoms that include:
- Chest pain
- Shortness of breath