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Case Reports
. 2024 Jan 15;14(1):125.
doi: 10.3390/life14010125.

Transapical Approach to Septal Myectomy for Hypertrophic Cardiomyopathy

Alexander Afanasyev  1 , Alexander Bogachev-Prokophiev  1 , Sergei Zheleznev  1 , Mikhail Ovcharov  1 , Anton Zalesov  1 , Ravil Sharifulin  1 , Igor' Demin  1 , Bashir Tsaroev  1 , Vladimir Nazarov  1 , Alexander Chernyavskiy  1
Affiliations
Case Reports

Transapical Approach to Septal Myectomy for Hypertrophic Cardiomyopathy

Alexander Afanasyev et al. Life (Basel). .

Abstract

A 63-year-old symptomatic female with apical hypertrophic cardiomyopathy and diastolic disfunction was admitted to the hospital. What is the best way to manage this patient? This study is a literature review that was performed to answer this question. The following PubMed search strategy was used: 'Hypertrophic obstructive cardiomyopathy' [All Fields] OR 'apical myectomy' [All Fields], NOT 'animal [mh]' NOT 'human [mh]' NOT 'comment [All Fields]' OR 'editorial [All Fields]' OR 'meta-analysis [All Fields]' OR 'practice-guideline [All Fields]' OR 'review [All Fields]' OR 'pediatrics [mh]'. The natural history of the disease has a benign prognosis; however, a watchful strategy was associated with the risk of adverse cardiovacular events. Contrastingly, transapical myectomy was associated with low surgical risk and acceptable outcomes. In our case, the patient underwent transapical myectomy with an unconventional post-operative period. Control echocardiography showed marked left ventricular (LV) cavity enlargement: LV end-diastolic volume, 74 mL; LV ejection fraction, 65%; and LV stroke volume index increased to 27 mL/m2. The patient was discharged 7 days after myectomy. At 6 months post-operation, the patient was NYHA Class I, with a 6 min walk test score of 420 m. Therefore, transapical myectomy may be considered as a feasible procedure in patients with apical hypertrophic cardiomyopathy and progressive heart failure.

Keywords: apical myectomy; cardiac transplantation; heart failure; hypertrophic cardiomyopathy; left ventricular outflow obstruction.

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Conflict of interest statement

The authors declare no conflicts of interest.

Figures

Figure 1
Figure 1
Preoperative echocardiography of patient with apical hypertrophic cardiomyopathy.
Figure 2
Figure 2
Cardiac magnetic resonance imaging of patient with apical hypertrophic cardiomyopathy.
Figure 3
Figure 3
Intraoperative view of transapical myectomy.
Figure 4
Figure 4
Echocardiography of patient with apical hypertrophic cardiomyopathy after transapical myectomy.
Figure 5
Figure 5
Cardiac magnetic resonance imaging of patient with apical hypertrophic cardiomyopathy after transapical myectomy.
See this image and copyright information in PMC

References

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