Hypertrophic Cardiomyopathy: What is it and how is it treated?

Septal myectomy is a surgical procedure performed to reduce the muscle thickening that occurs in patients with hypertrophic cardiomyopathy (HCM). Septal myectomy is one treatment option for HCM when symptoms persist despite optimal treatment with medications, or if obstruction severely restricts blood ejection from the heart.

During the septal myectomy procedure, the surgeon removes a small amount of the thickened septal wall to widen the outflow tract from the left ventricle to the aorta. This eliminates the obstruction and the mitral valve regurgitation that occurs with this condition. Patients often experience rapid relief of symptoms after the procedure.

During the septal myectomy procedure, the surgeon removes a small amount of the thickened septal wall to widen the outflow tract from the left ventricle to the aorta.

Who is eligible for the myectomy procedure?

Patients with a diagnosis of hypertrophic cardiomyopathy should be assessed at an experienced center to determine the severity of their condition and to develop a treatment plan.

It is estimated that obstruction occurs in more than 70 percent of patients with HCM. The severity of obstruction, symptoms and the patient’s response to medications vary greatly. Many patients have no symptoms or mild obstruction and can be treated with medications like beta blockers or calcium channel blockers.

Septal myectomy is the safest, most successful and most durable procedure for patients with severe symptoms or severe obstruction. Elderly patients or those with advanced medical conditions may be better served by percutaneous alcohol septal reduction.

Hypertrophic cardiomyopathy (HCM) is a complex type of heart disease associated with a thickening of the heart muscle, most commonly at the septum (the muscular wall that separates the left and right side of the heart), just below the aortic valve. If the septum becomes too thick, the passageway to the aorta becomes very narrow, limiting or blocking the flow of blood from the left ventricle to the aorta, called “outflow tract obstruction.” The septal thickening that results in obstruction varies from a few millimeters to centimeters. Mitral valve abnormalities are common and impact repair techniques.

How can I be evaluated for the septal myectomy procedure?

To determine if myectomy is the right treatment option, you’ll need to be evaluated by a Cleveland Clinic cardiologist. If you are currently being treated by a doctor outside of Cleveland Clinic, chat online with a nurse , or please call the Heart Center Resource and Information Nurse toll-free at 866.289.6911 or 216.445.9288 for more information about getting an evaluation at Cleveland Clinic.

If you are already being seen at Cleveland Clinic for treatment of your heart condition, ask your cardiologist if myectomy surgery might be an appropriate treatment option for you.

Will my symptoms improve after surgery?

Yes. Surgical results indicate that most patients experience significant symptom improvement and an improved quality of life after surgery.

Recovery

Full recovery from septal myectomy surgery takes about 6 to 8 weeks. Most patients are able to drive in about 3 to 8 weeks after surgery. Your doctor will provide specific guidelines for your recovery and return to work.

Follow Up Care

Your doctor will tell you when you need to have your first follow-up appointment. Regular follow-up appointments are important to evaluate your heart function and include a medical exam as well as diagnostic tests (such as an echocardiogram) to be repeated at regular intervals. During these appointments, your medications may be adjusted to relieve symptoms or optimize your heart function.

Even if you are not having symptoms and you feel fine, you must still see your doctor regularly. The frequency of your follow-up visits is based on your current health. In general, you will need to see your cardiologist for follow-up visits at least twice a year.

You should call your doctor if your symptoms become more severe or frequent. Don’t wait until your next appointment to discuss changes in your symptoms.

Importance of Making Lifestyle Changes

To maintain your health after surgery, it is important to take medications as prescribed and make lifestyle changes as recommended by your doctor to reduce the risk of disease progression or future disease. Lifestyle changes include:

  • Eat a heart-healthy diet that includes following a 2,000 mg sodium (salt) diet
  • Restrict fluids to 8 cups or less per day
  • Quit smoking and using tobacco
  • Treat high cholesterol
  • Manage high blood pressure and diabetes
  • Exercise regularly
  • Maintain a healthy weight
  • Weigh yourself every day and monitor for sudden weight gain of more than 2 pounds in a day or 5 pounds in a week; call your doctor if this occurs
  • Control stress and anger
  • Participate in a cardiac rehabilitation program, as recommended
  • Follow up with your doctor regularly, as scheduled