Extended Myectomy for Hypertrophic Obstructive Cardiomyopathy


  • Changqing Gao
  • Chonglei Ren
  • Cangsong Xiao
  • Yang Wu
  • Gang Wang
  • Guopeng Liu
  • Yao Wang




Background: The purpose of this study was to summarize our experience of extended ventricular septal myectomy in patients with hypertrophic obstructive cardiomyopathy (HOCM).

Methods: Thirty-eight patients (26 men, 12 women) with HOCM underwent extended ventricular septal myectomy. The mean age was 36.3 years (range, 18-64 years). Diagnosis was made by echocardiography. The mean (mean ± SE) systolic gradient between the left ventricle (LV) and the aorta was 89.3 ± 31.1 mm Hg (range, 50-184 mm Hg) according to echocardiographic assessments before the operations. Moderate or severe systolic anterior motion (SAM) of the anterior leaflet of the mitral valve was found in 38 cases, and mitral regurgitation was present in 29 cases. Extended ventricular septal myectomy was performed in all 38 cases. The results of the surgical procedures were evaluated intraoperatively with transesophageal echocardiography (TEE) and with transthoracic echocardiography (TTE) at 1 to 2 weeks after the operation. All patients were followed up with TTE after their operation.

Results: All patients were discharged without complications. The TEE evaluations showed that the mean systolic gradient between the LV and the aorta decreased from 94.8 ± 35.6 mm Hg preoperatively to 13.6 ± 10.8 mm Hg postoperatively (P = .0000) and that the mean thickness of the ventricular septum decreased from 28.3 ± 7.9 mm to 11.8 ± 3.2 mm (P = .0000). Mitral regurgitation and SAM were significantly reduced or eliminated. During the follow-up, all patients promptly became completely asymptomatic or complained of mild effort dyspnea only, and syncope was abolished. TTE examinations showed that the postoperative pressure gradient either remained the same or diminished.

Conclusions: Extended ventricular septal myectomy is mostly an effective method for patients with HOCM, and good surgical exposure and thorough excision of the hypertrophic septum are of paramount importance for a successful surgery.


Alam M, Dokainish H, Lakkis NM. 2009. Hypertrophic obstructive cardiomyopathy— alcohol septal ablation vs. myectomy: a meta-analysis. Eur Heart J 30:1080-7.nAshikhmina EA, Schaff HV, Ommen SR, Dearani JA, Nishimura RA, Abel MD. 2011. Intraoperative direct measurement of left ventricular outflow tract gradients to guide surgical myectomy for hypertrophic cardiomyopathy. J Thorac Cardiovasc Surg 142:53-9.nBrown ML, Schaf HV. 2008. Surgical management of obstructive hypertrophic cardiomyopathy: the gold standard. Expert Rev Cardiovasc Ther 6:715-22.nKirklin JW, Barratt-Boyes BG. 1993. Cardiac surgery. 3rd ed. New York, NY: Churchill Livingstone. p 1717.nKrajcer Z, Leachman RD, Cooley DA, Coronado R. 1989. Septal myotomy-myomectomy versus mitral valve replacement in hypertrophic cardiomyopathy. Ten-year follow-up in 185 patients. Circulation 80(Pt 1):I57-64.nMaron BJ. 2002. Hypertrophic cardiomyopathy: a systematic review. JAMA 287:1308-20.nMaron BJ. 2007. Controversies in cardiovascular medicine. Surgical myectomy remains the primary treatment option for severely symptomatic patients with obstructive hypertrophic cardiomyopathy. Circulation 116:196-206.nMaron BJ, Dearani, JA, Ommen SR, et al. 2004. The case for surgery in obstructive hypertrophic cardiomyopathy. J Am Coll Cardiol 44:2044-53.nMaron BJ, McKenna WJ, Danielson GK, et al. 2003. American College of Cardiology/European Society of Cardiology clinical expert consensus document on hypertrophic cardiomyopathy. A report of the American College of Cardiology Task Force on Clinical Expert Consensus Documents and the European Society of Cardiology Committee for Practice Guidelines. Eur Heart J 24:1965-91.nMaron MS, Olivotto I, Betocchi S, et al. 2003. Effect of left ventricular outflow tract obstruction on clinical outcome in hypertrophic cardiomyopathy. N Engl J Med;348:295-303.nMaron MS, Olivotto I, Zenovich AG, et al. 2006. Hypertrophic cardiomyopathy is predominantly a disease of left ventricular outflow tract obstruction. Circulation 114:2232-9.nMorrow AG, Fogarty TJ, Hannah H 3rd, Braunwald E. 1968. Operative treatment in idiopathic hypertrophic subaortic stenosis. Techniques and the results of preoperative and postoperative clinical and hemodynamic assessments. Circulation 37:589-96.nOmmen SR, Maron BJ, Olivotto I, et al. 2005. Long-term effects of surgical septal myectomy on survival in patients with obstructive hypertrophic cardiomyopathy. J Am Coll Cardiol 46:470-6.nSmedira NG, Lytle BW, Lever HM, et al. 2008. Current effectiveness and risks of isolated septal myectomy for hypertrophic obstructive cardiomyopathy. Ann Thorac Surg 85:127-33.nSpirito P, Autore C. 2006. Management of hypertrophic cardiomyopathy. BMJ 332:1251-5.nWang S, Cui B, Sun H, et al. 2009. Clinical experience of surgical treatment on hypertrophic obstructive cardiomyopathy [in Chinese]. Natl Med J China. 89:2776-8.nWatkins H, McKenna WJ. 2005. The prognostic impact of septal myectomy in obstructive hypertrophic cardiomyopathy. J Am Coll Cardiol 46:470-6.n



How to Cite

Gao, C., Ren, C., Xiao, C., Wu, Y., Wang, G., Liu, G., & Wang, Y. (2012). Extended Myectomy for Hypertrophic Obstructive Cardiomyopathy. The Heart Surgery Forum, 15(5), E251-E256. https://doi.org/10.1532/HSF98.20111185