Introduction
Septal myectomy is a surgical procedure that aims at restoring blood flow by removing hypertrophic or thickened cardiac (heart) tissue. This procedure is advised when medications fail to treat hypertrophic cardiomyopathy.
What Is Hypertrophic Cardiomyopathy (HCM)?
Hypertrophic cardiomyopathy is a genetic disorder of cardiac muscle tissue characterized by abnormal thickening of the cardiac muscle tissue without any clear cause. The stiffened, thickened walls reduce and impede normal blood flow. It is the second most common cardiomyopathy (a condition that makes it difficult for the heart to pump blood effectively), with a prevalence of around 1 in 500. It is the most frequent cause of sudden cardiac death in young patients. Although males and females are equally affected, females are more likely to present with more significant heart failure symptoms at an older age. It is inherited in an autosomal dominant fashion, and the genetic abnormalities occur primarily in the following genes:
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MYH7.
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MYBPC3.
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TNNT2.
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TNNI3.
Septal myectomy is a noninvasive procedure that helps visualize the lungs, heart, and airways.
What Are the Prerequisites for Septal Myectomy?
Before the surgery, the following diagnostic tests are performed to assess the health of the patient:
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Chest X-Ray - It is a non-invasive procedure that helps visualize the lungs, heart, and airways. With the help of specialized beams (called X-ray beams), it captures images of bones in the spine and chest, as well as images of the heart, lungs, and airways. It is a completely painless procedure that produces black-and-white images of the chest cavity.
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Electrocardiogram (ECG or EKG) - It is a rapid and painless test that records electrical impulses from the heart. With the help of several sensors (electrodes attached to various parts of the body), an electrocardiogram permits the detection of irregular heartbeats. Additionally, it also helps identify the source of the irregular heartbeats.
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Echocardiogram (ECHO) - An echocardiogram, often known as the ECHO scan, is a diagnostic test used to evaluate the heart and nearby blood vessels. It is a cardiac ultrasound test in which a tiny probe transmits high-frequency sound waves that create echoes after bouncing off from various body tissues. The probe detects these echoes during the scan and converts them into moving images on a monitor.
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Cardiac Catheterization - A conventional angiography or cardiac catheterization has long been the go-to test for determining a person’s heart health. A traditional coronary angiogram is an invasive procedure that requires inserting a catheter (a small, flexible tube) into the blood vessel. Doctors often recommend contrast angiography which entails injecting a specialized dye (also known as contrast). The use of contrast enhances the images.
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Blood Tests - Several blood tests, such as thyroid function tests, liver function tests, etc., are performed to assess the functioning of all organs.
The physician will also ask to stop certain medications along with the above-mentioned diagnostic tests. The medications include - blood thinners (such as Aspirin or Warfarin).
How Is Septal Myectomy Performed?
Septal myectomy is a three to four-hour-long surgical procedure and is performed in the following way:
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To start with, the patient is administered general anesthesia. This helps the surgeon to perform the surgery easily while the patient is in a deep sleep and not feeling any pain.
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Once asleep, the surgeon makes a large incision (surgical cut) in the middle of the chest to gain access to the heart, separating the sternum (breastbone). The incision can be as long as eight to ten inches long.
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After that, the patient is connected to a machine known as a heart-lung machine. The heart-lung machine, also known as the cardiopulmonary bypass machine, is an apparatus that substitutes for the heart’s pumping function and increases blood oxygen concentration. As a result, the heart will remain motionless during the procedure, which is required when the heart must be opened (open heart surgery).
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After heart and lung function have been stabilized with the help of the external machine (heart-lung machine), the surgeon removes the excess cardiac tissue (hypertrophic or thickened heart muscle).
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Post removal of the tissue, the patient is disconnected from the heart-lung machine, and heart function is assessed. After the heart usually beats, the surgeon puts the sternum back together.
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The surgical site or incisions are closed with the help of bandages, sutures, and staples.
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After the surgery, the patient is shifted to ICU (intensive care unit) and is monitored regularly.
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Post-surgery, a chest tube for the drainage of excess fluid and a urine catheter is placed for at least forty-eight hours.
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In most cases, recovery happens within a week under hospital supervision.
What Is a Heart-Lung Machine?
The heart-lung machine, also known as the cardiopulmonary bypass machine, is an apparatus that substitutes for the heart’s pumping action and increases the blood’s oxygen concentration. As a result, the heart will remain motionless during the procedure, a prerequisite for open heart surgeries. It functions like the heart and lungs when plugged into the heart-lung machine. The heart-lung machine transports blood from the right atrium, the heart’s upper-right chamber, to an oxygenator, a highly specialized reservoir. The red blood cells receive oxygen within the oxygenator as it bubbles up through the blood. Due to oxygenation, the blood turns bright red instead of dark red (low in oxygen). The blood is then passed through a plastic tube to the aorta (the body’s primary blood channel) after a filter eliminates the air bubbles from the oxygen-rich blood. The blood circulates throughout the body from the aorta. The heart and lungs can be replaced for hours with a heart-lung machine.
What Are the Advantages of Septal Myectomy?
Septal myectomy has several advantages. It helps relieve the following symptoms-
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Angina (chest pain).
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Dyspnea (shortness of breath).
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Syncope (loss of consciousness).
What Are the Complications Associated With Septal Myectomy?
Although septal myectomy is a relatively safe procedure, complications usually arise in individuals who have the following risk factors-
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Age above 60 years.
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Tobacco abuse.
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Underlying heart conditions.
The following complications are seen in high-risk individuals -
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Fluid build-up around the heart and lungs.
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Heart blocks.
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Atrial fibrillation (a heart condition in which electrical impulses travel through the upper chambers of the heart (right and left atrium) in a disorganized manner which results in the muscle fibers contracting at different times, making the heart appear as if it is twitching or quivering).
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Arrhythmias (irregular heartbeats).
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Infection.
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Bleeding.
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Cardiac tamponade (a condition in which there is a buildup of fluid around the heart that puts pressure and obstructs blood flow within the heart).
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Blood clots (can eventually lead to stroke or heart attack).
Conclusion
Septal myectomy is a surgical procedure (type of open heart surgery), which helps restore blood flow by removing the hypertrophied heart muscle. The stiffened, thickened walls reduce and impede normal blood flow. Septal myectomy has been associated with high success rates and the patient recovers within a week, under hospital supervision.
