Septal myectomy for obstructive hypertrophic cardiomyopathy

Septal myectomy effectively relieves left ventricular outflow tract obstruction (LVOTO) and cardiac symptoms in both adults and children with obstructive hypertrophic cardiomyopathy (HCM). Abnormal attachments of the papillary muscles and chordae and other cardiac lesions can be repaired at the same time. Early mortality for isolated septal myectomy in both children and adults is low (0% to 2.5%). Median echocardiographic LVOT gradients at rest on late follow-up have been as low as 0 to 5 mm Hg. Symptomatic improvements after myectomy occurs in the majority; 90% of patients improve by at least one functional class, and most remain improved on late follow-up. Late survivorship compares very favorably with the natural history of nonoperated patients with symptomatic obstructive HCM. These results serve as a basis for comparison with newer nonsurgical alternatives.