176-I * TRANSAPICAL APPROACH IN REDO MYECTOMY FOR HYPERTROPHIC CARDIOMYOPATHY

Abstract

Objectives: Reoperation for recurrent or residual gradients after septal myectomy offers symptomatic relief and restores life span. In selected patients, septal myectomy needs to be performed through a transapical approach. Methods: We present the case of a 35-year-old female that underwent transaortic septal myectomy 2 years ago. She presented with class IV symptoms and significant residual obstruction. Additionally she had severe tricuspid regurgitation secondary to an internal cardiodefibrillator lead. Echocardiographic evaluation demonstrated subaortic and midventricular obstruction. We describe our surgical approach. Results: She underwent redo sternotomy and tricuspid valve repair. A repeat transaortic myectomy was attempted but exposure of septum was not appropriate and we performed a midventricular and low subaortic septal myectomy through an apical incision. Conclusion: Transapical septal myectomy is safe and provides excellent exposure for midventricular obstruction relief. In selected patients with difficult transaortic exposure it may allow basal myectomy. Complete relief of obstruction improves symptoms.