Septal myectomy | |
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Specialty | Cardiology |
Septal myectomy is a cardiac surgery treatment for hypertrophic cardiomyopathy (HCM). [1] The open-heart surgery entails removing a portion of the septum that is obstructing the flow of blood from the left ventricle to the aorta. [2]
The most common alternatives to septal myectomies are treatment with medication (usually beta or calcium blockers) or non-surgical thinning of tissue with alcohol ablation. Ordinarily, septal myectomies are performed only after attempts at treatment with medication fail. The choice between septal myectomy and alcohol ablation is a complex medical decision.[ citation needed ]
Septal myectomy was established by Andrew G. Morrow in the 1960s. [3]
Septal myectomy is associated with a low perioperative mortality and a high late survival rate. A study at the Mayo Clinic found surgical myectomy performed to relieve outflow obstruction and severe symptoms in HCM was associated with long-term survival equivalent to that of the general population, and superior to obstructive HCM without operation. The results are shown below: [4]
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Either alcohol ablation or myectomy offers substantial clinical improvement for patients with hypertrophic obstructive cardiomyopathy. One non-randomized comparison suggested that hemodynamic resolution of the obstruction and its sequelae are more complete with myectomy. [5] Whether one or the other treatment is preferable for certain patient types is debated among cardiovascular scientists. [6]
Cardiomyopathy is a group of diseases that affect the heart muscle. Early on there may be few or no symptoms. As the disease worsens, shortness of breath, feeling tired, and swelling of the legs may occur, due to the onset of heart failure. An irregular heart beat and fainting may occur. Those affected are at an increased risk of sudden cardiac death.
Troponin, or the troponin complex, is a complex of three regulatory proteins that are integral to muscle contraction in skeletal muscle and cardiac muscle, but not smooth muscle. Measurements of cardiac-specific troponins I and T are extensively used as diagnostic and prognostic indicators in the management of myocardial infarction and acute coronary syndrome. Blood troponin levels may be used as a diagnostic marker for stroke or other myocardial injury that is ongoing, although the sensitivity of this measurement is low.
Hypertrophic cardiomyopathy is a condition in which muscle tissues of the heart become thickened without an obvious cause. The parts of the heart most commonly affected are the interventricular septum and the ventricles. This results in the heart being less able to pump blood effectively and also may cause electrical conduction problems.
Ventricular hypertrophy (VH) is thickening of the walls of a ventricle of the heart. Although left ventricular hypertrophy (LVH) is more common, right ventricular hypertrophy (RVH), as well as concurrent hypertrophy of both ventricles can also occur.
T wave alternans (TWA) is a periodic beat-to-beat variation in the amplitude or shape of the T wave in an electrocardiogram TWA was first described in 1908. At that time, only large variations could be detected. Those large TWAs were associated with increased susceptibility to lethal ventricular tachycardias.
Cardiomegaly is a medical condition in which the heart becomes enlarged. It is more commonly referred to simply as "having an enlarged heart". It is usually the result of underlying conditions that make the heart work harder, such as obesity, heart valve disease, high blood pressure (hypertension), and coronary artery disease. Cardiomyopathy is also associated with cardiomegaly.
Disopyramide is an antiarrhythmic medication used in the treatment of ventricular tachycardia. It is a sodium channel blocker and is classified as a Class 1a anti-arrhythmic agent. Disopyramide has a negative inotropic effect on the ventricular myocardium, significantly decreasing the contractility. Disopyramide also has an anticholinergic effect on the heart which accounts for many adverse side effects. Disopyramide is available in both oral and intravenous forms, and has a low degree of toxicity.
Myocardial rupture is a laceration of the ventricles or atria of the heart, of the interatrial or interventricular septum, or of the papillary muscles. It is most commonly seen as a serious sequela of an acute myocardial infarction.
Alcohol septal ablation (ASA) is a minimally invasive heart procedure to treat hypertrophic cardiomyopathy (HCM).
Noncompaction cardiomyopathy (NCC) is a rare congenital disease of heart muscle that affects both children and adults. It results from abnormal prenatal development of heart muscle.
Alan W. Heldman is an American interventional cardiologist. Heldman graduated from Harvard College, University of Alabama School of Medicine, and completed residency and fellowship training at Johns Hopkins University School of Medicine. He held positions on the faculty of Johns Hopkins from 1995 to 2007. In 2007, he became clinical chief of cardiology at the University of Miami's Leonard M. Miller School of Medicine.
Myosin heavy chain, α isoform (MHC-α) is a protein that in humans is encoded by the MYH6 gene. This isoform is distinct from the ventricular/slow myosin heavy chain isoform, MYH7, referred to as MHC-β. MHC-α isoform is expressed predominantly in human cardiac atria, exhibiting only minor expression in human cardiac ventricles. It is the major protein comprising the cardiac muscle thick filament, and functions in cardiac muscle contraction. Mutations in MYH6 have been associated with late-onset hypertrophic cardiomyopathy, atrial septal defects and sick sinus syndrome.
Gerald Murray Lawrie is an American heart surgeon and pioneer in the surgical treatment of valvular heart disease of Australian descent.
Hypertrophic cardiomyopathy screening is an assessment and testing to detect hypertrophic cardiomyopathy (HCM).
Left atrial appendage occlusion (LAAO), also referred to as left atrial appendage closure (LAAC), is a treatment strategy to reduce the risk of blood clots from the left atrial appendage entering the bloodstream and causing a stroke in those with non-valvular atrial fibrillation (AF). The left atrial appendage can be occluded, closed, by an endovascular implant, or by ligation. Occlusion of the left atrial appendage is presently approached with medical devices that can be deployed inside of the heart or externally as a ligature. In non-valvular AF, over 90% of stroke-causing clots that come from the heart are formed in the left atrial appendage.
Management of heart failure requires a multimodal approach. It involves a combination of lifestyle modifications, medications, and possibly the use of devices or surgery.
Ulrich Sigwart is a German retired cardiologist known for his pioneering role in the conception and clinical use of stents to keep blood vessels open, and introducing a non-surgical intervention, alcohol septal ablation for the treatment of hypertrophic obstructive cardiomyopathy.
Srihari S. Naidu is an American physician and Professor of Medicine at New York Medical College who is known for his work on hypertrophic cardiomyopathy including the procedure known as alcohol septal ablation, and for helping to construct the universal diagnostic criteria for cardiogenic shock.
Charles Knight MD FRCP OBE is a British professor of cardiology and chief executive of St Bartholomew's Hospital, part of Barts Health NHS Trust.
Andrew G. Morrow , was chief of surgery at the National Heart Institute, who established the septal myectomy operation for obstructive hypertrophic cardiomyopathy (HCM). In 1960 he was part of the team that performed the first successful human mitral valve replacement using Nina Starr Braunwald's design.