Dr. Sushant Srivastava
Director & Sr. Consultant
Cardiothoracic & Vascular
Surgery, BLK Heart Centre
BLK Super Speciality
Hospital, New Delhi
Risky But Not Impossible
Surgery for Hypertrophic Obstructive Cardiomyopathy
Hypertrophic Obstructive Cardiomyopathy is a serious condition
in which there is progressive left ventricular outflow obstruction
due to assymetrical hypertrophy of the interventricular septum.
Abnormal movement of the anterior mitral valve leaflet when the
ventricle is ejecting can increase the gradient. These patients are
prone to ventricular arrhythmias and sudden death is also reported in
certain cases. Treatment is medical, catheter-based septal ablation or
A 62-year old lady was admitted in BLK Super Speciality Hospital with
progressive Angina on exertion for six months. She underwent transthoracic
and transesophageal ECHO which revealed Asymmetrical
Septal Hypertrophy with a narrowed left ventricular outflow, a
calcified aortic valve with significant aortic stenosis and regurgitation.
The total gradient across the LVOT and aortic valve was 70mm Hg.
Coronary Angiography was normal.
A decision to operate upon the patient was made. She was counselled
about the risk involved. The operation was conducted through a
median sternotomy. The patient was placed on cardio pulmonary
bypass. The aorta was opened obliquely and the diseased aortic valve
was excised. The hypertrophied septum was seen bulging into the LV
A No. 15 blade was carefully inserted into the septum underneath
the right coronary sinus end, advanced 2.5 cm towards the apex.
A parallel incision was made 1 cm apart and the hypertrophic
myocardium was resected. The LVOT opened up well, aortic valve
replacement was done with a No. 18 ATS prosthetic valve. Weaning
from bypass was uneventful and the post-operative gradient by TEE
dropped to 24 mmHg.
The operation was successful with the desired outcome. The recovery
process was uneventful and the patient was discharged after proper
Surgery for Hypertrophic Obstructive Cardiomyopathy is demanding
and requires precision. Post operatively, a small risk of ventricular
arrhythmias persists hence, the patient is advised to be on beta
blockers. Symptomatic improvement is dramatic and the risk declines