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Septal Myectomy


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  • Septal Myectomy

    [Septal Myectomy]

    Author: Darek (---.globalcrossing.com)

    Date: 11-22-02 08:26

    Hello all. I have recently come across a few articles pertaining to a procedure done in Cleveland called a septal myectomy. Unfortunately, I can't find detailed information on it and was hoping someone here could tell me exactly what it entails ie. the procedure and what it cures. I have read that it can reduce the size of an enlarged septum which seems like a total cure to me but of course I am skeptical about such claims. Has anyone here had this done or can give me some more information about it? Thanks!


    [Re: Septal Myectomy]

    Author: Sarah B. Board Moderator (12.144.99.---)

    Date: 11-22-02 08:39

    Dear Darek,

    Boy, have you come to the right place!!!

    First, read the rest of the information found on the links from the home page about HCM, etc. Then, come back here to the message board and use the Search link at the top of the board to find all the posts about myectomy --there are a lot. You may want to go back beyond just the last 30 or 60 days, too, when you have time.

    In answer to your question about a cure --no, there is no "cure" for HCM since it is a genetic disorder that causes the heart muscle tissue to be disorganized and full of extra gunk it doesn't need or want (this is all in the info section).

    What a myectomy DOES do is to remove the piece of the septum (middle wall between ventricles) that is blocking the mitral valve from working properly. This opens up the blood's pathway so that the heart works better --but still not necessarily 100%. Most people find they are much improved after a myectomy and there are about half a dozen regular posters here who have had them this year.

    OH ---The Cleveland Clinic is just one of several centers that is qualified to perform myectomies --The Mayo Clinic and the Minneapolis Heart Institute and a few others.



    [Re: Septal Myectomy]

    Author: Lisa Salberg (---.dyn.optonline.net)

    Date: 11-22-02 09:28


    While you are right that the myectomy may sound like a "cure" but it is not. HCM is a genetic condition that alters the cell structure of the heart. Myectomies and other forms of septal reduction can reduce the obstruction in the outflow tract of the left ventricle. the most common complaints that are improved by these procedures are chest pain and shortness of breath. Only those with gradents of 50+ are offered myectomy other forms of septal reduction are offered to those with gradients of 30 or greater.

    Symptoms to continue after the procedure but are greatly reduced in many cases. The goal of these procedures is to improve quality of life.

    Mayo Clinic and the Cleveland Clinic preform the largest numbers of myectomies in the USA each year.

    Any more questions ...ask away!



    [Re: Septal Myectomy]

    Author: Vickie (---.se.client2.attbi.com)

    Date: 11-22-02 11:52


    Is the gradient you refer to as 50 a resting gradient or a provocable gradient? I have posted before about continued symptoms despite max doses of Atenolol, Norpace, and Cardizem. I had the pacer/defib implanted in September. I wasn't ready to see a specialist after 2 1/2 years of trying to treat this locally with my own cardiologist. Well, I now have an appt with Dr Lever at CCF Dec.4 and have imagined every possible scenario. I was strongly opposed to surgery/ alcohol ablation before and now find myself anxiously hoping that I qualify for either one. My numbers are not that terrible with a septum 1.6 on last echo and with a gradient <50 at rest but with a provocable gradient>150 on Dobutamine stress and >200 during pacer insertion. I am very symptomatic with SOB with minimal exertion, chest pain, and occasional dizziness. My worst fear is that I will be sent away from CCF without a recommendation for either procedure because my numbers are just not that bad.What were the other things you could do for septal reduction for those with resting greadients >30 that you referred to in your post? Also, I am scheduled for an echo, 3d echo, and metabolic stress echo. What exactly is the last one? I have not heard of that before. For the record, having my pacer/defib put in has not helped me at all. For the first 6 weeks, I was more SOB than ever.That gradually got less but I am still just as SOB as I was before they put the pacer in. Last week, they tried to make an adjustment by lengthening the PR interval. This relieved my SOB almost immediately, but My chest pain increased tenfold. I am 47 years old so I guess that I am not in the group that the pacer seems to relieve symptoms, but it was worth a shot and it is there if my heart rate drops again as it has done in the past (I am on 150 mg of Atenolol daily). Thanks to all who persisted in encouraging me to seek out an HCM specialist even when I wasn't ready and thanks to this message board for providing me with more knowledge than I have found anywhere else. Also thanks to Dolly W and Robert Hartwell who have e-mailed me and provided me with lots of support.


    [Re: Septal Myectomy]

    Author: Sarah B. Board Moderator (12.144.99.---)

    Date: 11-22-02 12:27

    Dear Vickie,

    You say your septum is 1.6 but you don't mention obstruction. Only someone whose septum is blocking the mitral valve is a candidate for a myectomy or an ablation as the entire purpose of those procedures is to remove the obstruction.

    The CCF is one of the best and they will help you if there is any western medicine that will make a difference in your quality of life.

    keep us posted!!



    [Re: Septal Myectomy]

    Author: Lisa Salberg (---.dyn.optonline.net)

    Date: 11-22-02 14:32

    Sarah - I think she did say she had a gradient of under 50 at rest provocable to over 150... with a septal measurement of 1.6 if it would be anything I think you will be looking at myectomy. Most center like to see a septum of 1.8 or greater (I think thats a good #) as a minimum measurement to use alcohol on.

    Go to CCF, let them take a look at you and go from there... we are here when you need us!



    [Re: Septal Myectomy]

    Author: Robert Hartwell (---.focal3.interaccess.com)

    Date: 11-23-02 05:44

    Darek and Vicki,

    I am almost two weeks post-op from a septal myectomy done at the Cleveland Clinic. While I still have post surgery aches, I do notice a difference in things like stair climbing (slowly of course! ). Myectomy can relieve symptoms from what I call the physical side of HCM but as was mentioned earlier, does nothing for the electrical side.

    If either of you wish further information about the procedures and what to expect, please feel free to e-mail me directly.



    [Re: Septal Myectomy]

    Author: Mary S. (---.net237.fl.sprint-hsd.net)

    Date: 11-23-02 07:50

    What is exactly is a normal resting gradient for the heart? My resting gradient is 55-60 but all the docs have said it is normal. Also what is chordal SAM vs valvular Sam? Is one any worse than the other? One of my echos say I have chordal SAM.

    Any answers would be appreciated!

    Mary S.


    [Re: Septal Myectomy]

    Author: Shirley (---.grosep01.mi.comcast.net)

    Date: 11-23-02 15:20

    I had a septal myectomy at CCF March 28, 2002. It was not necessary to also replace my mitral valve although that was on the agenda. The reduction did the trick, thank goodness. I had previously had the alcohol ablation at Houston Heart Clinic, but it only gave me temporary relief.

    I am writing to say that now, in late November 8 mos. post-op, I am finally feeling really good, better and more energetic than I have in 20 years (I am 63). I was only diagnosed three years ago and went rapidly downhill. I had expected to feel better right away (silly me), and had somewhat resigned myself to the low level of activity I could manage. I went back to work May 1, but since I am a psychotherapist, my work is not physically tiring. One thing I did right after getting back to work was design a new component of my practice, Heart Surgery Coaching which I do by phone. The surgery experience was so traumatizing to me that I felt others must feel the same. Indeed, my doctor says people do suffer from depression and high stress in the immediate weeks after the surgery.

    I wish those of you who end up having surgery great good luck. I felt very safe and was well cared for at CCF although I am sure other facilities are as good.

    Warm regards,

    NOTE: This is a post from the previous forum message board.