Modified surgical approach to symptomatic hypertrophic cardiomyopathy with abnormal papillary muscle morphology: Septal myectomy plus papillary muscle repositioning

Abstract

The Morrow procedure uses a midline sternotomy, with the left ventricle and septum accessed by the aortic valve through a vertical aortotomy. 4 The potential limitations of the procedure include small, but persistent, risks of an aortotomy (eg, postoperative bleeding, aortic dissection), difficulties with visualizing the surgical anatomy, and the risk of aortic valve damage (approximately 5% rate of moderate aortic regurgitation postoperatively 5 ).A robotic approach using the left atrium and across the mitral valve is an alternative and more direct route to the ventricular septum that can circumvent the limitations of the standard transaortic approach. The required robotic manipulation of the mitral valve for left ventricular septum access seems less risky than the transaortic route across the often friable aortic valve for provoking valvular damage.Although additional studies are needed to evaluate the frequency of associated complications, our robot-assisted technique could be an acceptable alternative to the Morrow procedure.

Excision of anomalous muscle bundles as an important addition to extended septal myectomy for treatment of left ventricular outflow tract obstruction

“…At the latest follow-up (14 months [IQR, [7][8][9][10][11][12][13][14][15][16][17][18][19][20][21][22][23][24]), most of the patients were in acceptable physical state. Two male patients aged 15 and 14 years died of suspected sudden cardiac arrest 15 and 16 months after the operation, respectively.…”

“…12,13 Many procedures, including valve plication, papillary muscle repositioning, and secondary chordae cutting, have been reported to address mitral anomalies. [14][15][16] Gruner and colleagues 17 reported that left ventricular apical-basal muscle bundles were detected by cardiac magnetic resonance imaging in 63% of patients with HCM. In the present study, we report a large amount of data on detailed intraventricular anomalies that were directly observed by the operator.…”

Robotic trans-atrial and trans-mitral ventricular septal resection

“…In addition, the risk of heart block can be minimized by beginning the septal resection at the nadir of the right aortic cusp and continuing it toward the left fibrous trigone. A hypertrophic anterior papillary muscle can supplement outflow tract obstruction, and muscular attachments to the septum must be divided (4). This should allow free motion of chordae tendineae and anterior mitral leaflet away from the septum during systole.…”

Enlargement Of Left Ventricular Outflow Tract Using An Autologous Pericardial Patch For The Anterior Mitral Valve Leaflet And Septal Myectomy Through Trans-mitral Approach For The Treatment Of Hypertrophic Obstructive Cardiomyopathy

“…Although there are many different surgical approaches and methods, the modi ed Morrow procedure through trans-aortic approach is still considered as the gold standard surgical treatment, showing a veri ed surgical result and good remission of symptoms for a long time [8,9,11]. The trans-mitral approach was rstly described in 1963 by Lillehei and Levy [10].…”