Septal myectomy, also known as septal myotomy, is a cardiac surgery treatment for hypertrophic cardiomyopathy (HCM). HCM is a type of heart disease associated with asymmetric thickening of the heart muscle, most commonly at the septum (membrane that separates the right and left sides of the heart). This thickening may result in left ventricular outflow tract obstruction (or blockage of the blood exiting from the heart). The surgery involves removing a portion of the septum that is obstructing the flow of blood from the left ventricle to the aorta.

Septal myectomy is considered by experts to be the most effective and low-risk treatment for symptoms of HCM.

What does septal myectomy treat?

Septal myectomy should be considered if you have left ventricular outflow tract obstruction and do not respond to medical therapy. Some recent studies have also suggested that septal myectomy may reduce the risk of sudden death associated with hypertrophic cardiomyopathy.

Septal myectomy appears to be lower risk as a surgical treatment for hypertropic cardiomyopathy, compared to alcohol/ethanol ablation. Septal myectomy has a higher success rate and a lower risk of needing pacemaker after the procedure.

What to expect during septal myectomy

Preparing for your procedure

Prior to your septal myectomy, you’ll meet with your doctor to discuss your medical history, the medicines you take and any questions you have about the procedure.

During your procedure

Septal myectomy requires general anesthesia and cardiopulmonary bypass, a machine that takes over the functions of the heart and lungs. The procedure lasts three to four hours.

Your surgeon makes an incision in the center of the chest to access the heart. After cardiopulmonary bypass has begun, an incision is made in the aorta. Your surgeon enters the heart through the aortic valve and cuts away a portion of the thickened muscle. This physically increases the space inside the left ventricle and removes the obstruction in the heart.

After your procedure

After your surgery, you are transferred to an intensive care unit for one to two days. The recovery staff closely monitors your heart, blood pressure, oxygen and vital signs. This procedure usually requires five to six days in the hospital. Many patients go back to work in as little as six weeks.

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