If medication doesn’t alleviate the symptoms of hypertrophic cardiomyopathy, your NYU Langone doctor may recommend surgery to manage the condition.
For people who have significant obstruction to blood flow from the heart, surgeons may perform a septal myectomy to reduce the thickening of the heart’s septum, the wall that separates the organ’s left and right pumping chambers.
A septal myectomy can lessen left ventricular outflow obstruction and mitral valve regurgitation, a condition in which blood flows backward into the atrium, or upper chamber of the heart. This most often improves symptoms.
In this procedure, the surgeon removes part of the muscle in the wall of the septum to widen the left ventricle outflow—the opening through which blood flows from the heart—and prevents it from blocking blood flow to the aorta, the body’s largest artery.
During a septal myectomy, our surgeons frequently also repair an abnormal mitral valve, the gateway between the heart’s left upper chamber, which receives blood from the lungs, and the left lower chamber, which pumps blood to the body through the aorta. Problems with the mitral valve are often associated with obstruction in people with hypertrophic cardiomyopathy. Called an anterior mitral leaflet plication, this surgical procedure shortens, stiffens, and decreases any slack in the mitral valve to prevent abnormal motion.
A septal myectomy is open heart surgery and requires general anesthesia. Because the heart needs to remain still during the procedure, a heart–lung bypass machine is used to perform the work of these organs.
Before surgery, your cardiac surgeon discusses the expected benefits and risks of the procedure.
During the procedure, your NYU Langone surgeon makes an incision in the chest that is six inches long and divides the breastbone. He or she then uses surgical instruments to reach the thickened septum through the aortic valve, the gateway between the left ventricle and the aorta. The surgery takes four hours.
The procedure helps blood to flow properly through the mitral valve. Our surgeons typically repair the person’s own mitral valve rather than replace it with an artificial valve, because artificial valves may need to be replaced later in life and require the lifelong use of anticoagulants.
After surgery, you remain in the intensive care unit for 24 hours, so your doctor can monitor you closely for potential complications, such as infection. Cardiac rehabilitation specialists from NYU Langone’s Rusk Rehabilitation aid your recovery by helping you to slowly increase your activity level. Most people can walk carefully by the third day after surgery and remain in the hospital for five to seven days.
Your doctor may restrict your activity while you recover at home. This may involve avoiding driving for two weeks after surgery and not traveling to work for a month. During this period, many people work at home.
For some people with obstruction—those who aren’t healthy enough for open heart surgery and in whom medication doesn’t work—our doctors may recommend a minimally invasive procedure called alcohol septal ablation. This procedure thins the heart’s thickened septum but does not require a surgical incision in the chest or the use of a heart–lung bypass machine.
In this procedure, which is performed with sedation, highly concentrated alcohol is injected through a catheter into an artery near the heart’s enlarged septum. This causes tissue in the area to die. In time, scar tissue—which is thinner—replaces the dead tissue, leading to less obstruction and improved blood flow from the heart.
This procedure requires a five-day hospital stay, and your activity at home is then restricted for another two to four weeks.
Your doctor can discuss the benefits and risks of this procedure if you are a candidate.
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