Septal myectomy is a surgical procedure primarily performed to treat patients with hypertrophic obstructive cardiomyopathy (HOCM), a condition characterized by an abnormal thickening of the heart muscle, particularly the interventricular septum. This thickening can obstruct blood flow from the left ventricle to the aorta, leading to symptoms such as shortness of breath, chest pain, and fatigue, which can significantly impair a patient's quality of life. During the procedure, a surgeon removes a portion of the thickened septal tissue, effectively widening the outflow tract and allowing for improved blood flow. The operation is typically performed under general anesthesia and involves an open-heart approach, meaning that the chest is opened to access the heart directly. Before surgery, the patient undergoes a comprehensive evaluation, including echocardiograms, cardiac MRI, and possibly genetic testing, to confirm the diagnosis and assess the severity of the condition. Once the anesthetic takes effect, the patient is placed on a heart-lung machine to take over the function of the heart and lungs during the procedure. The surgical team carefully navigates to the cardiac structures, identifies the excessive septal tissue contributing to outflow obstruction, and excises a tailored portion of this thickened area. Importantly, the amount of tissue removed is precise, as over-resection can lead to complications such as ventricular arrhythmias or mitral valve insufficiency. Following the removal of the septal tissue, the heart is then restarted, and the surgeon checks for any residual obstruction or abnormalities. The closure of the chest involves careful stitching of the breastbone and surrounding tissues, and the entire procedure typically lasts several hours. Postoperatively, patients are closely monitored in the ICU for a couple of days before transitioning to a regular hospital room. The recovery period can vary, but most patients can expect to stay in the hospital for about a week, with full recovery taking several weeks to months. After undergoing a septal myectomy, many patients experience significant improvements in their symptoms, increased exercise tolerance, and enhanced quality of life, often leading to a better prognosis. However, as with any surgery, there are risks involved, including infection, bleeding, or complications related to anesthesia. Long-term follow-up is essential to monitor heart function and screen for any potential residual issues. In certain cases, patients may also be advised about ongoing management strategies, including lifestyle modifications and medication adjustments. Overall, septal myectomy represents a vital option for those with medically refractory HOCM, aiming to alleviate symptoms and improve overall heart function.
