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Review
. 2017 Jul;6(4):318-328.
doi: 10.21037/acs.2017.04.03.

Surgical treatment for hypertrophic cardiomyopathy: a historical perspective

Dustin Hang  1 , Anita Nguyen  1 , Hartzell V Schaff  1
Affiliations
Review

Surgical treatment for hypertrophic cardiomyopathy: a historical perspective

Dustin Hang et al. Ann Cardiothorac Surg. 2017 Jul.

Abstract

Our understanding of hypertrophic cardiomyopathy (HCM) as a disease entity has increased dramatically over the last half century. There has been a concerted effort by several surgical groups to develop operative techniques to relieve left ventricular outflow tract (LVOT) obstruction and alleviate symptoms. This paper traces the development of transaortic septal myectomy, the current gold standard therapy for relief of LVOT obstruction, in symptomatic patients refractory to medical treatment. In addition, we introduce newer methods for myectomy that have expanded the role of surgery in patients with various forms of HCM.

Keywords: Hypertrophic cardiomyopathy (HCM); history; septal myectomy.

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Conflict of interest statement

Conflicts of Interest: The authors have no conflicts of interest to declare.

Figures

Figure 1
Figure 1
A pathologic specimen from a report by Dr. Robert Donald Teare at St. George’s Hospital in London demonstrating asymmetrical hypertrophy of the left ventricle, most notably of the interventricular septum (7) (Copyrighted and used with permission of BMJ Publishing Group Ltd.).
Figure 2
Figure 2
The transaortic and transventricular approach utilized by Drs. Kirklin and Ellis at the Mayo Clinic in the early 1960s to excise hypertrophied septum in the LVOT (10) (Copyrighted and used with permission of Wolters Kluwer Health, Inc.).
Figure 3
Figure 3
The traditional Morrow technique utilizing parallel incisions into the hypertrophied septum followed by excision of the resulting bar of septal muscle (20) (Copyrighted and used with permission of Wolters Kluwer Health, Inc.).
Figure 4
Figure 4
Operative steps of the current Mayo Clinic technique, demonstrating an initial excision of the hypertrophied septum at the point of mitral-septal contact (i.e., white fibrous scar) in Panels A and B, followed by extension of the excision towards the apex of the left ventricle after adequate exposure in Panel C (Copyrighted and used with permission of Mayo Foundation for Medical Education and Research).
Figure 5
Figure 5
Panel A depicts an anomalous papillary muscle inserting directly into the body of the mitral leaflet, resulting in obstruction by contact between the papillary muscle and septum (black arrows). Panel B demonstrates a different configuration of an anomalous papillary muscle inserting into the leaflet edge, which does not result in contact between the papillary muscle and septum (Copyrighted and used with permission of Mayo Foundation for Medical Education and Research).
Figure 6
Figure 6
Long segment septal hypertrophy involving both the subaortic and midventricular regions (Copyrighted and used with permission of Mayo Foundation for Medical Education and Research).
Video
Video
Surgical treatment for hypertrophic cardiomyopathy: a historical perspective.
See this image and copyright information in PMC

References

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