Surgical Indications for Hypertrophic Cardiomyopathy

Hypertrophic cardiomyopathy (HCM) is a genetic heart condition characterized by abnormal thickening of the heart muscle, particularly the left ventricle. While many patients can be managed with medications and lifestyle modifications, certain cases require surgical intervention to alleviate symptoms and improve quality of life.

When Is Surgery Recommended?

Surgery is typically considered for patients who do not respond to medical therapy and continue to experience significant symptoms such as chest pain, shortness of breath, and palpitations. These symptoms often indicate a more severe form of the disease that requires a more aggressive treatment approach.

Severe Heart Failure Symptoms

Patients classified as New York Heart Association (NYHA) functional class III or IV are often candidates for surgery. These individuals typically experience marked limitations in physical activity or are unable to perform any physical activity without discomfort. In such cases, surgical options can significantly improve heart function and overall well-being.

Significant Left Ventricular Outflow Tract Obstruction

Another key indication for surgery is the presence of a severe left ventricular outflow tract obstruction (LVOTO). This is defined as a resting or provoked pressure gradient of more than 50 mmHg across the outflow tract. This obstruction can lead to impaired blood flow from the heart and cause serious complications if left untreated.

Common Surgical Procedures

The most common surgical treatment for HCM is septal myectomy, also known as septal resection. This procedure involves removing a portion of the thickened heart muscle to relieve the obstruction and improve blood flow. It is a well-established and effective method for reducing symptoms and enhancing cardiac function.

Mitral Valve Replacement

In some patients, particularly those with severe mitral regurgitation due to structural issues such as a prolapsed mitral valve, mitral valve replacement may be necessary. This procedure helps restore normal blood flow through the heart and prevents further damage to the cardiac system.

Overall, surgical treatment for hypertrophic cardiomyopathy is tailored to the individual patient's condition and symptoms. A comprehensive evaluation by a cardiac team is essential to determine the most appropriate intervention and ensure optimal outcomes.