Most obstructive HCM patients remain asymptomatic for life or have symptoms well-controlled with appropriate medication. However, when symptoms persist or medication causes troublesome side effects, several excellent options exist to eliminate obstruction and improve symptoms.
Septal myectomy surgically reduces the thickening of your heart muscle. Following a chest incision, your heart is stopped and a bypass machine takes over the work of your heart and lungs. Through a subsequent incision in your lower aorta, a portion of your septal wall is thinned via resection, or surgical removal, thereby eliminating any blood flow obstruction. Your heart’s pressures return to normal, and your HCM symptoms are dramatically improved or eliminated. The average hospital stay for this procedure is five days, after which most patients go home for a six- to eight-week recovery period before returning to a normal routine.
A small number of patients require surgery (find out more about surgical septal myectomy), but if it is necessary, our HCM Center has one of the most experienced and effective surgical programs to relieve obstruction and symptoms in HCM patients. Over the last 15 years, Hassan Rastegar, MD, has successfully operated on 550 people, and more than 90% of his patients return to a normal lifestyle.
Is there an alternative to myectomy surgery?
Yes. If you have significant symptoms due to obstruction and have not benefited from drugs and if you do not qualify for, or choose, the myectomy operation, alcohol septal ablation is a reasonable and effective alternative for some older patients. Dr. Carey Kimmelstiel has safely and effectively performed more than 100 such interventional alcohol septal ablation procedures which is performed in the cardiac catheterization laboratory at Tufts MC without general anesthesia and mimics the myectomy by relieving obstruction and symptoms.
Alcohol septal ablation is a minimally invasive catheter-based procedure to reduce the thickening of your heart muscle. Through a small incision at the top of your leg, a catheter is inserted into your femoral artery and advanced to your heart’s septal artery. After a tiny balloon at the tip of the catheter inflates to block blood flow, one to two milliliters of 100% ethyl alcohol flows through the catheter into your septal artery. The alcohol causes small, controlled heart damage, which—after the surgery and over the course of several weeks to months—reduces the thickness of the septum, eliminating blood flow obstruction, restoring your heart’s pressures to normal, and resulting in a significant improvement or elimination of heart failure symptoms. The average stay in the hospital for this procedure is four days, after which most patients go home to a seven- to ten-day recovery period before returning to a normal routine.
Implantable cardioverter defibrillator (ICD)
HCM patients at high risk for sudden death may be candidates for an implanted cardioverter defibrillator or ICD: a sophisticated device permanently inserted under the skin, capable of sensing potentially lethal arrhythmias and automatically terminating them by shocking to return a normal rhythm. Only a very small percentage of HCM patients are at increased risk for these arrhythmias.
Subcutaneous Implantable cardioverter defibrillator (ICD)
Over the years, the ICD device has become smaller and easier to implant, currently requiring only an overnight stay in the hospital. The traditional transvenous ICD is implanted just under the collar bone, with lead wires introduced to the heart chambers through the veins. The newer subcutaneous ICD sits adjacent to the left rib cage with leads just under the skin and requires no wires. Both devices have potential benefits which our team will discuss with you in detail should an ICD need arise.