Transaortic septal myectomy: techniques and pitfalls

Hypertrophic cardiomyopathy (HCM) is the most common congenital cardiac disease, affecting up to 1 in 200 individuals. When it causes left ventricular outflow tract (LVOT) obstruction, treatment is indicated to reduce symptoms and the risk of sudden cardiac death. Pharmacologic therapy is the first line treatment, however if it fails, surgical myectomy or percutaneous ablation of the hypertrophic myocardium are the standard therapies to eliminate subaortic obstruction. Both surgical myectomy and percutaneous ablation have been demonstrated as safe and effective treatments; however, myectomy is the gold standard with a significantly lower complication rate and more complete and longstanding reduction of LVOT obstruction.