Transapical myectomy as an alternative to heart transplantation in patient with apical hypertrophic cardiomyopathy

• Afanasyev A.V.
• Bogachev-Prokofiev A.V.
• Kirilova V.S.
• Volkova I.I.
• Kashapov R.I.
• Shajahmetova S.V.
• Zalesov A.S.
• Pivkin A.N.
• Nazarov V.M.
• Chernyavskiy A.M.

Abstract

41 y.o. female patient with NYHA class III was admitted to the hospital with dyspnea and angina occurred during ordinal physical activities despite of provided medical therapy. Echo data: LV volume 56 ml, maximal LV wall thickness 19 mm, LVEF 67%, LVEDV 46 ml, LVSV 28 ml. Resting LVOT gradient 8 mm Hg. During the last 6 months patient has been included  at heart transplant waitlist. In term of severely symptomatic status, progressive heart failure, LV apical aneurysm formation with transmural fibrosis, ineffective medical therapy, significant LVEDV and LVSV reduction, and low surgical risk patient was scheduled to transapical myectomy as an alternative to heart transplantation. Postoperative period was unconventional. Echo: LV volume 51 ml, maximal LV wall thickness 15 mm, LVEF 72%, LVEDV 88 ml, LVSV 63 ml. Resting LVOT gradient 7 mm Hg. Cardiac output has  increased from 2.1l/min to 4.6l/min, 6MWT has increased from less than 50 m to 200 m. Conclusion. Severely symptomatic patients with apical HCM, significant LV diastolic disfunction and small LV cavity should be considered as candidates to transapical myectomy, in particular as an alternative to heart transplantation.

Keywords:hypertrophic cardiomyopathy; transapical myectomy

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