Name of the Procedure:

Ventriculomyotomy (also known as myectomy) for Idiopathic Hypertrophic Subaortic Stenosis (IHSS), eg, asymmetric septal hypertrophy.

Summary

A ventriculomyotomy, often referred to as a septal myectomy, is a surgical procedure performed to reduce the thickened heart muscle that obstructs blood flow from the left ventricle to the aorta. This operation is typically used to treat patients with significant hypertrophic cardiomyopathy when other treatments have not been effective.

Purpose

The procedure addresses idiopathic hypertrophic subaortic stenosis, a condition where the heart muscle is abnormally thickened, leading to obstruction of blood flow. The main goals are to relieve symptoms such as chest pain, shortness of breath, and fainting, as well as to improve overall heart function and quality of life.

Indications

• Severe symptoms of heart failure (e.g., shortness of breath, chest pain)
• Syncope (fainting) episodes
• Significant obstruction of blood flow from the left ventricle
• Failure to respond to medication and other less invasive treatments

Preparation

• Patients may need to fast for 8-12 hours prior to the surgery.
• Medication adjustments might be required; for example, blood thinners may need to be paused.
• Pre-procedure diagnostic tests typically include an echocardiogram, MRI, and possibly a cardiac catheterization.

Procedure Description

1. The patient is placed under general anesthesia.
2. An incision is made in the chest to access the heart.
3. The surgeon opens the chest and heart to reach the thickened septum.
4. Part of the thickened heart muscle is carefully removed to widen the pathway for blood flow.
5. The incision in the heart is closed, and the chest is then closed with sutures or staples.
6. The patient is monitored for any immediate complications post-surgery.

Tools and equipment used include a scalpel, suction devices, sutures, and a heart-lung machine to circulate blood during the surgery.

Duration

The procedure typically takes between 3 to 4 hours.

Setting

This procedure is performed in a hospital operating room equipped with cardiac surgery facilities.

Personnel

• Cardiothoracic surgeon
• Anesthesiologist
• Surgical nurses
• Perfusionist (operates the heart-lung machine)
• Operating room technicians

Risks and Complications

• Infection
• Bleeding
• Arrhythmias (irregular heartbeats)
• Heart attack
• Stroke
• Death (rare, but serious)

Benefits

• Relief from symptoms such as chest pain, shortness of breath, and fatigue.
• Improved quality of life.
• Enhanced heart function.
• Most patients notice substantial improvements within weeks after the procedure.

Recovery

• Hospital stay of about 5 to 7 days.
• Gradual return to normal activities over about 6 to 12 weeks.
• Regular follow-up appointments with a cardiologist.
• Temporary restrictions on heavy lifting and strenuous activities.

Alternatives

• Medications (e.g., beta-blockers, calcium channel blockers)
• Alcohol septal ablation (a less invasive procedure)
• Implantable cardioverter-defibrillator (ICD)
• Risk and benefits of alternative treatments can vary; for instance, medication may not be effective for severe obstruction and alcohol septal ablation carries its own risks.

Patient Experience

• During the procedure, the patient will be under general anesthesia and won’t feel anything.
• After the surgery, pain and discomfort in the chest area are common and will be managed with medications.
• Patients might experience fatigue and limited mobility initially but will gradually recuperate.
• Regular monitoring and support from healthcare providers throughout the recovery period will help manage complications and ensure a smooth recovery process.