why can't myectomies be done with no obstruction?

[vondhe Contributor-in-Training Find all posts View Profile Close vondhe]

Hello all who are more knowledgeable about this than I am. I have been told that I am not a candidate for myectomy because I don't have an obstruction. Can someone help me to understand why it is that a thinning of the septum alone can't be helpful? That is, why does myectomy work with and not without an outflow obstruction?

Many thanks for any info you can provide. My local cardiologist is a good guy but no expert on HCM and had thought I could have a myectomy until we learned that I "needed" the obstruction to be a candidate, so he is no more knowledgeable than I am on this issue.

Heather

[Reenie Super Moderator Find all posts View Profile Close Reenie]

The myectomy's sole purpose is to relieve the obstruction. Thinning the muscle is how this is accomplished, but the only symptoms it relieves are the ones caused by the obstruction. You are still prone to electrical problems with an HCM heart whether it's thinned or not. It will still not relax like a normal heart. Even after a myectomy you still have HCM, it's not a cure. Is your doctor open to learning more about HCM? If not, I would like to respectfully nudge you to get a new doctor. I hope this answers some of your questions.

Reenie

[shirleymahoney Brave Heart Find all posts View Profile Close shirleymahoney]

Like Reenie said this surgery is not a cure by no mean it just relieves the symptoms from the obstruction you will still always have HCM, I think i would go to your doctor and sit and have a long talk with him if you haven't already

Shirley

[Toogoofy317 Member of 1000 Post Club! Find all posts View Profile Close Toogoofy317]

It is interesting that you bring this question up. My local cardio and I were discussing this today as a matter of fact. He is quite up to date on HCM and knows traditionally that is the case. Us non-obstructed ones tend to be the hard ones to treat. I know in my instance we have tried every cardiac med known to man and my bp just won't tollerate the side effects. So now we have started just doing pain management. I don't see that as a long term thing though. I have a life and I want to get into research and medicine and being on narcotics won't help that aspect.

So, coming back to the myectomy. My cardiologist said it may be plausible to cut out my large septum and to also try to add some extra arteries. But, the biggest draw back is that it would be the only time its ever been done. I am very unique in that HCM is not my only problem. My vascular system is also very small. It cannot supply enough oxygen to my enlarged heart so I get chronic chest pain.

So pretty much my cardio says the book has officially been thrown out on me and I am a very rare case. So everything that is done now is all experimentall. Yippee nothing like being a guinea pig!

mary S.

[Lisa Salberg HCMA CEO and Founder Find all posts View Profile Close Lisa Salberg]

Myectomies were designed to remove obstruction. The thought of removing extra 'thickness' just to thin out the septum, while an interesting idea does not seem to lead to any net benefit to the heart. The myectomy removes the portion of the septum that interferes with the outflow of blood. To simply thin the septum may lead to a slightly larger LV cavity however it will likely not change any symptoms. Further it may cause the heart to move into a dilated state as in the case of 'end stage' or burnt out HCM.

The majority of those seeking a myectomy have symptoms of chest pain and SOB relieved. Those symptoms are directly related to obstruction.

I hope this helps.
Lisa

[vondhe Contributor-in-Training Find all posts View Profile Close vondhe]

thanks

Thank you all so much for quick and informative replies.

Heather

[Reenie Super Moderator Find all posts View Profile Close Reenie]

You're welcome, Heather.

Reenie

[Degrand Shy Heart Find all posts View Profile Close Degrand]

Sob

What is SOB in this context?

[Reenie Super Moderator Find all posts View Profile Close Reenie]

SOB is shortness of breath. Welcome to the HCMA.

Reenie