Surgical myectomy is highly effective in treating HOCM. Since the disease may present in different anatomic forms, those patients with more extensive disease pose surgical challenges. For instance, in those patients with apical and mid/apical hyperthrophy, surgery often requires a combined transaortic and transapical approaches. However, one may argue that a successful basal myectomy would be a safer and equally effective treatment, leaving untreated the mid septum and/or apical septum. What is the validity of this later argument, in terms of recurrent heart failure and sudden death?
In extensive disease, extensive surgical myectomy should be done. Bcz in conservative myectomy, SAM will be prevented and some extent of diastolic dysfunction. But if apical basal is untreated, then diastolic dysfunction will not improved up to the mark. And another concensus that, if myectomy was done already, it will be better to treat medically or alcoholic ablation. Otherwise ultimately redo surgery will be required.
I would like to raise one point. Doing alcohol ablation after myectomy one has to be cautious about the fact the patient does not have any bundle branch block or else he will develop a complete heart block. As of redo surgery it is extremely difficult after previous myectomy . It is best that myectomy when done the first time be done properly.
Hypothetically apical hypertrophy can be managed by ablation of distal septal branches( or even Left Circumflex artery distal branches-theory no evidence present).
Do we need treatment for Apical hypertrophy, How will it help hemodynamics or symptoms or longevity ?
There are reports only for mid cavity HCM, where in late stage LV dysfunction is more frequent than outflow obstruction.
Dr. Rajeev Lochan, Consultant Interventional Cardiologist with special interest in Septal ablation, HOD cardiology, Medeor Hospital, Dubai, UAE
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