A septal myectomy is a type of open-heart surgery performed to relieve symptoms caused by a thickened heart muscle. The procedure involves the surgical removal of a small amount of the overgrown muscle tissue, which allows blood to flow more freely from the heart. This operation is a well-established treatment to improve heart function and quality of life when medical therapies have not been sufficiently effective.
The Underlying Condition Treated
Septal myectomy is the definitive treatment for the obstructive form of a genetic disease called hypertrophic cardiomyopathy (HCM). In this condition, the muscular wall separating the heart’s lower chambers, the septum, becomes unusually thick. This thickening can bulge into the left ventricle, the heart’s main pumping chamber. This creates a blockage that makes it harder for the heart to pump oxygen-rich blood to the rest of the body.
The narrowing of this pathway, called the left ventricular outflow tract, forces the heart to work under higher pressure. This leads to symptoms that can significantly impact daily activities. Patients often experience shortness of breath, particularly with exertion, chest pain (angina), fatigue, lightheadedness, or fainting spells. These symptoms arise because the body is not receiving an adequate supply of blood.
Medical management, involving medications like beta-blockers or calcium channel blockers, is the first line of defense to control symptoms. These drugs help relax the heart muscle and slow the heart rate, giving the ventricle more time to fill with blood between beats. When symptoms remain severe despite optimal medical therapy, a septal myectomy is considered. The surgery offers a mechanical fix to the anatomical problem that medications cannot resolve.
The Surgical Procedure
The procedure begins with the patient under general anesthesia. To access the heart, the surgeon performs a median sternotomy, which involves making an incision down the center of the chest and dividing the breastbone. This approach provides a direct view of the heart and major blood vessels for the operation.
Once the heart is exposed, the patient is connected to a cardiopulmonary bypass, or heart-lung, machine. This technology temporarily takes over the functions of the heart and lungs. It circulates and oxygenates the blood so the surgeon can operate on a still, bloodless heart, ensuring vital organs receive oxygen throughout the surgery.
With the bypass machine running, the surgeon works through the aorta and the aortic valve. Using specialized instruments, they carefully shave away and remove the excess muscle from the thickened septum. The goal is to widen the outflow tract and eliminate the obstruction to blood flow.
After a sufficient amount of muscle is removed, the surgeon checks to ensure the pathway is clear. The heart is then restarted, the patient is weaned from the bypass machine, and the sternum and chest incision are closed.
Recovery and Rehabilitation
Following the surgery, the patient is moved to an intensive care unit (ICU) for close monitoring, which lasts for one to two days. During this time, healthcare staff monitor heart rate, blood pressure, and oxygen levels. Pain is managed with medication, and tubes placed to drain fluid from the chest are usually removed within this period.
Once stable, the patient is transferred to a regular cardiac care unit for the remainder of their hospital stay, which generally totals about five to seven days. The focus in this phase shifts toward gradual mobilization. Patients are encouraged to sit up, stand, and begin walking short distances with assistance. Breathing exercises are also introduced to help keep the lungs clear and prevent complications.
The recovery process continues for several weeks at home after discharge. Patients are given specific instructions to limit physical activity, which includes:
- Restricting driving for about four to six weeks.
- Avoiding lifting anything heavy to allow the breastbone to heal properly.
- Managing fatigue, as the body expends significant energy healing.
- Caring for the chest incision properly to prevent infection.
A structured cardiac rehabilitation program is a highly recommended component of the recovery journey. These medically supervised programs begin a few weeks after returning home and are designed to help patients safely regain physical strength and endurance. The regimen includes tailored exercises, education on heart-healthy living, and counseling to help manage stress.
Life After Septal Myectomy
For most individuals, life after a septal myectomy is marked by a lasting improvement in their health. The surgery has a high success rate, with studies showing that more than 90% of patients experience significant relief from their symptoms. This translates into a restored ability to engage in normal physical activities without debilitating shortness of breath or chest pain.
This improvement in symptoms leads to an enhanced quality of life. Patients who were once limited by their condition often find they can return to work, hobbies, and recreational activities. The long-term survival rate following myectomy is excellent and may be associated with a reduced risk of sudden cardiac death.
Long-term management still requires lifelong follow-up with a cardiologist. Regular check-ups, often including echocardiograms, are necessary to monitor heart function over time. While the surgery is effective, there is a small risk of developing heart rhythm disturbances, such as heart block. This might necessitate the implantation of a pacemaker as part of routine management to ensure continued heart health.