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| '''Editors-In-Chief:''' C. Michael Gibson, M.S., M.D. [mailto:mgibson@perfuse.org], Cafer Zorkun, M.D. [mailto:zorkun@perfuse.org], Caitlin J. Harrigan [mailto:charrigan@perfuse.org], Martin S. Maron, M.D., and Barry J. Maron, M.D. | | '''Editors-In-Chief:''' C. Michael Gibson, M.S., M.D. [mailto:mgibson@perfuse.org], Cafer Zorkun, M.D. [mailto:zorkun@perfuse.org], Caitlin J. Harrigan [mailto:charrigan@perfuse.org], Martin S. Maron, M.D., and Barry J. Maron, M.D. |
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| ==Surgical Myectomy==
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| Surgical [[septal myectomy]] is the gold standard for relief of symptoms for patients who do not experience relief of symptoms from medications<ref name="pmid11886323">{{cite journal| author=Maron BJ| title=Hypertrophic cardiomyopathy: a systematic review. | journal=JAMA | year= 2002 | volume= 287 | issue= 10 | pages= 1308-20 | pmid=11886323 | doi= | pmc= | url=http://www.ncbi.nlm.nih.gov/entrez/eutils/elink.fcgi?dbfrom=pubmed&tool=sumsearch.org/cite&retmode=ref&cmd=prlinks&id=11886323 }} </ref> <ref name="pmid12607696">{{cite journal| author=Sherrid MV, Chaudhry FA, Swistel DG| title=Obstructive hypertrophic cardiomyopathy: echocardiography, pathophysiology, and the continuing evolution of surgery for obstruction. | journal=Ann Thorac Surg | year= 2003 | volume= 75 | issue= 2 | pages= 620-32 | pmid=12607696 | doi= | pmc= | url= }} </ref> <ref name="pmid7671349">{{cite journal| author=Wigle ED, Rakowski H, Kimball BP, Williams WG| title=Hypertrophic cardiomyopathy. Clinical spectrum and treatment. | journal=Circulation | year= 1995 | volume= 92 | issue= 7 | pages= 1680-92 | pmid=7671349 | doi= | pmc= | url= }} </ref> <ref name="pmid14607462">{{cite journal| author=Maron BJ, McKenna WJ, Danielson GK, Kappenberger LJ, Kuhn HJ, Seidman CE et al.| title=American College of Cardiology/European Society of Cardiology clinical expert consensus document on hypertrophic cardiomyopathy. A report of the American College of Cardiology Foundation Task Force on Clinical Expert Consensus Documents and the European Society of Cardiology Committee for Practice Guidelines. | journal=J Am Coll Cardiol | year= 2003 | volume= 42 | issue= 9 | pages= 1687-713 | pmid=14607462 | doi= | pmc= | url=http://www.ncbi.nlm.nih.gov/entrez/eutils/elink.fcgi?dbfrom=pubmed&tool=sumsearch.org/cite&retmode=ref&cmd=prlinks&id=14607462 }} </ref> <ref name="pmid15837258">{{cite journal| author=Sherrid MV, Barac I, McKenna WJ, Elliott PM, Dickie S, Chojnowska L et al.| title=Multicenter study of the efficacy and safety of disopyramide in obstructive hypertrophic cardiomyopathy. | journal=J Am Coll Cardiol | year= 2005 | volume= 45 | issue= 8 | pages= 1251-8 | pmid=15837258 | doi=10.1016/j.jacc.2005.01.012 | pmc= | url=http://www.ncbi.nlm.nih.gov/entrez/eutils/elink.fcgi?dbfrom=pubmed&tool=sumsearch.org/cite&retmode=ref&cmd=prlinks&id=15837258 }} </ref> <ref name="pmid581298">{{cite journal| author=Morrow AG| title=Hypertrophic subaortic stenosis. Operative methods utilized to relieve left ventricular outflow obstruction. | journal=J Thorac Cardiovasc Surg | year= 1978 | volume= 76 | issue= 4 | pages= 423-30 | pmid=581298 | doi= | pmc= | url= }} </ref>.
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| It has been performed successfully for more than 25 years. Surgical septal myectomy uniformly decreases left ventricular outflow tract obstruction and improves symptoms, and in experienced centers has a surgical mortality of 1%. It involves a midline thoracotomy (general anesthesia, opening the chest, and cardiopulmonary bypass) and removing a portion of the interventricular septum<ref name="pmid11886323">{{cite journal| author=Maron BJ| title=Hypertrophic cardiomyopathy: a systematic review. | journal=JAMA | year= 2002 | volume= 287 | issue= 10 | pages= 1308-20 | pmid=11886323 | doi= | pmc= | url=http://www.ncbi.nlm.nih.gov/entrez/eutils/elink.fcgi?dbfrom=pubmed&tool=sumsearch.org/cite&retmode=ref&cmd=prlinks&id=11886323 }} </ref>. Surgical myectomy resection focused just on the subaortic septum, to increase the size of the outflow tract to reduce Venturi forces may be inadequate to abolish systolic anterior motion (SAM) of the anterior leaflet of the mitral valve. With this limited sort of resection the residual mid-septal bulge still redirects flow posteriorly: SAM persists because flow still gets behind the mitral valve. It is only when the deeper portion of the septal bulge is resected that flow is redirected anteriorly away from the mitral valve, abolishing SAM
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| <ref name="pmid12607696">{{cite journal| author=Sherrid MV, Chaudhry FA, Swistel DG| title=Obstructive hypertrophic cardiomyopathy: echocardiography, pathophysiology, and the continuing evolution of surgery for obstruction. | journal=Ann Thorac Surg | year= 2003 | volume= 75 | issue= 2 | pages= 620-32 | pmid=12607696 | doi= | pmc= | url= }} </ref>
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| <ref name="pmid8579024">{{cite journal| author=Nakatani S, Schwammenthal E, Lever HM, Levine RA, Lytle BW, Thomas JD| title=New insights into the reduction of mitral valve systolic anterior motion after ventricular septal myectomy in hypertrophic obstructive cardiomyopathy. | journal=Am Heart J | year= 1996 | volume= 131 | issue= 2 | pages= 294-300 | pmid=8579024 | doi= | pmc= | url=http://www.ncbi.nlm.nih.gov/entrez/eutils/elink.fcgi?dbfrom=pubmed&tool=sumsearch.org/cite&retmode=ref&cmd=prlinks&id=8579024 }} </ref>.
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| With this in mind, a modification of the Morrow myectomy termed extended myectomy, mobilization and partial excision of the papillary muscles has become the excision of choice
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| <ref name="pmid12607696">{{cite journal| author=Sherrid MV, Chaudhry FA, Swistel DG| title=Obstructive hypertrophic cardiomyopathy: echocardiography, pathophysiology, and the continuing evolution of surgery for obstruction. | journal=Ann Thorac Surg | year= 2003 | volume= 75 | issue= 2 | pages= 620-32 | pmid=12607696 | doi= | pmc= | url= }} </ref>
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| <ref name="pmid8067875">{{cite journal| author=Messmer BJ| title=Extended myectomy for hypertrophic obstructive cardiomyopathy. | journal=Ann Thorac Surg | year= 1994 | volume= 58 | issue= 2 | pages= 575-7 | pmid=8067875 | doi= | pmc= | url=http://www.ncbi.nlm.nih.gov/entrez/eutils/elink.fcgi?dbfrom=pubmed&tool=sumsearch.org/cite&retmode=ref&cmd=prlinks&id=8067875 }} </ref>
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| <ref name="pmid7586394">{{cite journal| author=Schoendube FA, Klues HG, Reith S, Flachskampf FA, Hanrath P, Messmer BJ| title=Long-term clinical and echocardiographic follow-up after surgical correction of hypertrophic obstructive cardiomyopathy with extended myectomy and reconstruction of the subvalvular mitral apparatus. | journal=Circulation | year= 1995 | volume= 92 | issue= 9 Suppl | pages= II122-7 | pmid=7586394 | doi= | pmc= | url= }} </ref>
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| <ref name="Balaram, Sherrid et al 2005">Balaram SK, Sherrid MV, DeRose JJ, Hillel Z, Winson G, Swistel DG. Beyond extended myectomy for hypertrophic cardiomyopathy: The RPR (Resection–Plication–Release) Repair. ''Annals of Thoracic Surgery'' 2005; '''80''':217–23</ref>.
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| In selected patients with particularly large redundant mitral valves, anterior leaflet plication may be added to complete separation of the mitral valve and outflow
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| <ref name="Balaram, Sherrid et al 2005"/>
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| <ref name="McIntosh, Maron et al 1992">McIntosh CL, Maron BJ, Cannon RO, Klues H. Initial results of combined anterior mitral valve plication and ventricular septal myotomy–myectomy for relief of left ventricular outflow obstruction in patients with hypertrophic cardiomyopathy. ''[[Circulation (journal)|Circulation]]'' 1992; '''86''':II 60–7</ref>.
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| ==Cardiac transplantation== | | ==Cardiac transplantation== |