Septal myectomy

Overview

An open-heart procedure called a septal myectomy is used to treat hypertrophic cardiomyopathy, a condition in which the heart muscle thickens. A section of thicker heart tissue is removed by the surgeon during the procedure. This facilitates easier blood flow through the heart.

The two bottom chambers of the heart, the left and right ventricles, are divided by a muscular wall known as the septum. Abnormal thickening of the ventricle walls and septum may occur in hypertrophic cardiomyopathy. It is possible for the septum to protrude into the left ventricle and partially obstruct the flow of blood to the body. This leads to increased workload on the heart and plays a role in the development of various disease symptoms, including tiredness and difficulty breathing.

Reasons for undergoing the procedure

When patients with hypertrophic cardiomyopathy whose symptoms have not improved with medication, healthcare providers typically suggest a septal myectomy. Healthcare provider might also recommend it for:

• Individuals who have a significant thickness into left ventricle.
• Individuals who desire to conceive despite not experiencing significant symptoms of hypertrophic cardiomyopathy.

Find out whether an individual are a good candidate for a septal myectomy by consulting with the healthcare provider. Discuss the advantages and disadvantages of the procedure with the healthcare provider. Surgery is frequently the better option for younger patients and those with more significant thickness. The patient may benefit more from surgery according to their septal anatomy.

Risk

Although the risks are rare, they do occasionally occur. Based on age and other factors, the specific risks will change. Discuss the concerns with the healthcare provider. The following are some of the potential risks includes:

• Fluid buildup around the heart or lungs.
• Irregular heart rhythms such as, atrial fibrillation, and heart blocks.
• Infection.
• Bleeding.
• Blood clots that may lead to stroke or heart attack.
• Issues with the aortic valve caused by the valve’s mobility during surgery.
• Too much cardiac muscle is removed.
• Issues with blood flow during surgery that may eventually cause the heart’s pumping function to deteriorate.

Before the procedure

The patient will receive instructions from the healthcare provider on how to get ready for a septal myectomy. The majority of people don’t require any extra actions. They may recommend to do the following:

• The night before the procedure, refrain from eating or drinking anything after midnight.
• Some medications, such blood thinners, may need to be stopped by the patient prior to the procedure.
• The patient may be asked by the healthcare provider to stop drinking and smoking.

Patients may need to arrive at the hospital the day before their scheduled procedure. During this time, they have the opportunity to ask any questions they may have about the upcoming surgery. Additionally, to assess their overall health before the surgery, they may undergo a series of routine tests. These tests could include:

• Blood tests.
• Chest x-ray.
• Electrocardiogram (ECG)
• Echocardiogram.
• Cardiac MRI.
• Cardiac catheterization.

During the procedure

Before the surgery begins, the patient will receive general anesthesia. This anesthesia ensures that patients are in a state of deep sleep throughout the procedure, effectively preventing them from experiencing any pain.

Once the patient has fallen asleep, the surgeon will conduct the following:

• To access the heart, a wide incision is made down the center of the chest, separating the breastbone (sternum).
• Attaches the patient to a heart-lung machine, which functions as their heart and lungs during the surgical procedure.
• Removes/cuts out the thickenedpart of the septum.
• Removes the patient off from the heart-lung machine.
• Puts back together the breastbone and uses absorbable sutures to close the incision.

Three to four hours are typically needed for a septal myectomy.

After the procedure

Following a septal myectomy, the patient will recover in the intensive care unit (ICU). For a period of 24 to 48 hours, they can have a chest drainage tube or urine catheter in place.

The medical team will closely monitor the patient’s heart rate and other vital signs during the procedure. To facilitate these checks, the patient may be connected to various monitoring devices.

Approximately 48 hours after the surgery, under the guidance of a physical therapist, the patient will commence walking with assistance. Typically, patients spend no more than five days in the hospital during their recovery period.

It is essential to arrange for the patient to have transportation home from the hospital, as they will require assistance at home for some time.

During a follow-up appointment scheduled for seven to ten days after the surgery, the patient will likely have their staples or stitches removed. It is crucial to attend all follow-up appointments as scheduled.

Outcome

Following surgery, the majority of patients with hypertrophic cardiomyopathy typically report improved well-being within several days to weeks. While some may experience slight chest tightness, severe pain is not expected.

Patients may initially experience increased fatigue but will gradually regain their energy during the recovery period, which can vary but generally spans a few weeks.

Septal myectomy is an effective treatment for hypertrophic cardiomyopathy, effectively addressing symptoms such as syncope, dyspnea (shortness of breath), and angina (chest pain).

The success rate of septal myectomy is quite high, with individuals who undergo this procedure experiencing long-term survival rates comparable to those of the general population.

Seek medical assistance if the patient has any symptoms following a septal myectomy that might indicate a problem, such as:

• Fever that exceeds 38 C, or 100.4 F.
• Warmth, swelling, or redness around the incision site.
• Gaining more than five pounds in a single week.

It is essential to adhere to all the guidance provided by your healthcare provider concerning your diet, exercise regimen, medication usage, and wound care.