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Review
. 2017 Jul;6(4):419-422.
doi: 10.21037/acs.2017.06.02.

Transapical approach for myectomy in hypertrophic cardiomyopathy

Kunal D Kotkar  1 , Sameh M Said  1 , Hartzell V Schaff  1
Affiliations
Review

Transapical approach for myectomy in hypertrophic cardiomyopathy

Kunal D Kotkar et al. Ann Cardiothorac Surg. 2017 Jul.
No abstract available

PubMed Disclaimer

Conflict of interest statement

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

Figures

Figure 1
Figure 1
A moist laparotomy pad is placed in the pericardial well behind the left ventricle, and the apex of the heart is delivered anteriorly. Solid and line show the location of the apical myectomy incision, lateral to the LAD. RV, right ventricle; LAD, left anterior descending coronary artery; LV, left ventricle.
Figure 2
Figure 2
The left anterior descending coronary artery (LAD) is identified, and an apical ventriculotomy is made lateral to it. This incision is located over the apical dimple when one is present (apical pouch), and it should be situated far enough to the left of the LAD to allow secure closure of the ventricle without compromise of the vessel. LAD, left anterior descending coronary artery; LV, left ventricle.
Figure 3
Figure 3
In apical hypertrophic cardiomyopathy, the left ventricular apex is usually obliterated by hypertrophied muscle, and care should be taken not to injure the papillary muscles and mitral valve apparatus.
Figure 4
Figure 4
Myectomy is performed removing septal muscle using No. 10 blade knife and scissors with the aid of small Volkmann retractors. The main focus of the procedure is on the ventricular septum with very little shaving done on the LV free wall (dashed line in the inset).
Figure 5
Figure 5
One can visualize the papillary muscles (solid arrow) and the chordae while looking through the ventriculotomy after the myectomy has been completed, and the papillary muscles can be shaved to further increase left ventricular volume and reduce risk of midventricular obstruction.
Figure 6
Figure 6
The left ventricle is irrigated to remove any debris or particulate matter, and the mitral valve apparatus is inspected to ensure that there has been no injury to it. The resection removes the mass of the myocardium occupying the left ventricular apex; thereby, augmentation of the left ventricular cavity is achieved.
Figure 7
Figure 7
We prefer a two-layer closure of the apical ventriculotomy using strips of teflon felt; the first is a running mattress suture of number 1-Ethibond, and the second is an over-and-over 0-prolene.
Video
Video
Transapical approach for myectomy in hypertrophic cardiomyopathy.
See this image and copyright information in PMC

References

    1. Said SM, Schaff HV, Abel MD, et al. Transapical approach for apical myectomy and relief of midventricular obstruction in hypertrophic cardiomyopathy. J Card Surg 2012;27:443-8. 10.1111/j.1540-8191.2012.01475.x - DOI - PubMed
    1. Schaff HV, Brown ML, Dearani JA, et al. Apical myectomy: a new surgical technique for management of severely symptomatic patients with apical hypertrophic cardiomyopathy. J Thorac Cardiovasc Surg 2010;139:634-40. 10.1016/j.jtcvs.2009.07.079 - DOI - PubMed

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