Obstructive hypertrophic cardiomyopathy (obstructive HCM) is a hereditary disease characterized by septal hypertrophy and dynamic left ventricular outflow tract (LVOT) obstruction. Other than hypertrophy, mitral valve abnormalities are also quite common in patients with obstructive HCM, which may contribute to systolic anterior motion (SAM) of the LVOT Surgical myectomy standard treatment achie...

The evolving alcohol septal ablation versus surgical myectomy controversy represents a crossroad in the management of obstructive hypertrophic cardiomyopathy (HCM). Indeed, in this now polarized debate within the cardiovascular community, between the traditional and established (ie, surgery) and the new and percutaneous (ie, ablation), much is at stake for the HCM patient population. Furthermor...

A 63-year old man with a significant left ventricular outflow obstruction due to an aberrant sub-valvular mitral tissue (not characteristic of a classical subaortic web; Fig. 1a and b), underwent resection of the mass and septal myectomy through a trans-aortic approach (Fig. 1c). Postoperative echocardiography demonstrated a reduction in the subaortic resting gradient of 70%, with no evidence o...

OBJECTIVES In hypertrophic cardiomyopathy (HCM) patients undergoing surgical myectomy, we sought to determine the association between pre-operative cardiac magnetic resonance (CMR) findings, small intramural coronary arteriole dysplasia (SICAD) on histopathology, and ventricular tachycardia (VT). BACKGROUND Myocardial scarring (fibrosis) and SICAD are frequently observed on histopathology in ...

METHODS We included 426 HCM patients (44 14 years; 78% men) undergoing exercise echocardiography, excluding hypertensive heart disease of elderly, ejection fraction <50% and invasive therapy (myectomy or alcohol ablation) during follow-up. Clinical, echocardiographic (LV thickness, LVOT gradient, and MR) and exercise variables (percent of age-sex predicted metabolic equivalents [METs] and heart...

A 61-year-old woman is a known case of hypertrophic cardiomyopathy (HCM) for three years. She has symptoms of breathlessness on exertion and fatigability. Her echocardiogram shows a mid-ventricular variant of HCM with an aneurysmal apical pouch. There is a midventricular gradient of 30–40 mmHg. There is no evidence of subaortic obstruction. We advised a trans-apical mid ventricular myectomy wit...

A 69-year-old male presented with obstructive hypertrophic cardiomyopathy, mitral valve regurgitation, and myxomatous mitral valve prolapse. A spontaneous chordal rupture and acute severe mitral regurgitation resulted in abrupt clinical deterioration despite complete relief of severe left ventricular outflow tract obstruction and systolic anterior motion of the anterior mitral leaflet. The pati...

Septal reduction therapy is accepted as a first therapeutic option for symptomatic drug-resistant hypertrophic obstructive cardiomyopathy (HOCM). Although, surgical septal myectomy is the gold standard method, alcohol septal ablation is a well-studied alternative approach in the patients with suitable anatomy. Endocardial septal ablation (ESA) therapy was relatively new defined modality and out...