Know About Septal Myectomy in Hypertrophic Cardiomyopathy

Septal myectomy is an open-heart surgery used to treat hypertrophic cardiomyopathy. In hypertrophic cardiomyopathy, the septum and the walls of the ventricles thicken abnormally. This, in turn, affects the blood flow to the heart and body.

During septal myectomy, the surgeon removes this thickened portion of the heart to enable blood to flow through the heart easily. It restores the blood flow to the heart. 

Anatomy and Physiology of the Heart 

The heart is a vital organ in the body located in the chest between the lungs.

1. It comprises two upper chambers called atria and two lower chambers called the ventricles.

2. The heart's primary function is to pump blood to all body parts.

3. The blood flows from the atria to the ventricles. While the left ventricle pumps blood to the rest of the body, the right ventricle pumps blood to the lungs.

4. A muscular wall called the septum separates the left and right ventricles. 

The symptoms of heart disease usually include fatigue, shortness of breath, perspiration, etc. These are observed in hypertrophic cardiomyopathy as well. 

A septal myectomysurgery is recommended in people whose symptoms haven't improved with medications. Other indications for this surgical procedure include the following:

1. People with severe left ventricle thickening

2. Women without severe HCM symptoms but want to conceive. This is because pregnancy in women with hypertrophic cardiomyopathy can be risky.

Many patients experience better long-term survival after the surgery. This results in a reduced need for additional cardiac procedures. The benefits of septal myectomy are:

1. Relieve Symptoms: It can alleviate symptoms like chest pain, shortness of breath, and fainting that may not respond to medications.

2. Reduced Heart Obstruction: The surgery removes the excess heart muscle causing obstruction. This allows for smoother blood flow and reduces the risk of complications.

3. Enhanced Exercise Tolerance: It often leads to improved exercise capacity and physical activity without the limitations imposed by the condition.

4. High Success Rate: Compared to septal ablation, which was earlier used to treat hypertrophic cardiomyopathy, septal myectomy has higher success rates. 

Many patients often wonder about the surgical process, and this section offers information on the expected preparations before and on the day of the procedure.

Before Septal Myectomy Surgery

Prior to septal myectomy surgery, the medical team follows protocols to guarantee patient safety.

On the Day of Septal Myectomy Surgery 

On the day of the surgery, the patient can expect to go through the following preparations:

The first step during a septal myectomy is administering general anaesthesia. This eases the patient into a deep sleep so they do not feel any pain throughout the procedure. The anaesthetic medication is given through a secure IV line. 

A septal myectomy procedure takes around three to four hours. During this time, the patient's family and friends are requested to stay in the waiting room until then.

The following steps are involved during the procedure:

1. The surgeon cleans the site and makes a large incision (cut in the skin) of around 6 to 8 inches down the middle of the chest. This separates the breast bone to reach the heart.

2. The individual is then connected to a heart-lung machine, which takes over the work of the heart and lungs during the procedure.

3. The thickened portion of the septum is then removed.

4. The individual is taken off the heart-lung machine to allow the heart to function normally.

5. The breast bone is put back together, and the incision is closed with absorbable sutures.

To ensure the patient is stable throughout the surgical procedure, their vitals are monitored before and after a septal myectomy. Patients are advised to sort out their insurance-related formalities before the procedure. This enables a hassle-free recovery and discharge later.

Septal myectomies have high success rates, which is over 90%. After the surgery, one can expect to feel soreness or discomfort.

The Recovery Process in Hospital

Once the surgery is completed, the patient is shifted to the intensive care unit (ICU). A urine catheter and a chest drainage tube are placed for 24-48 hours after the surgery. Patients are expected to recover in the hospital for around five days to a week, following which they are discharged. The recovery time following hospital discharge varies for every individual.

1. After the surgery, the patient will be closely monitored in the intensive care unit (ICU) to ensure vital signs, heart function, and overall condition are stable.

2. A breathing tube may be in place temporarily to help with breathing while under anaesthesia.

3. Patients will receive medications to manage discomfort and pain.

4. The surgical incision on the chest will be carefully monitored for signs of infection, and the dressing will be changed as needed.

5. The patient will receive fluids and nutrition through an intravenous (IV) line until they are ready to eat and drink normally.

6. If drains were placed during surgery to remove excess fluids, they will be removed as the patient recovers.

At-home Recovery

After a septal myectomy, the patient will require someone to drive them home from the hospital. They may also require help at home while they recover. Septal myectomy recovery time varies for each individual.

1. The stitches will be removed in the next follow-up appointment 7 to 10 days after the discharge. Patients are advised to keep their appointments and not miss them.

2. It is common for patients to get tired in the days after the surgery, but they will be able to find their strength soon.

3. Patients are advised not to lift heavy items for several weeks after the surgery.

4. Individuals should follow their doctor’s advice regarding medications, exercise, wound care and diet.

5. Complete recovery after the septal myectomy can take six to eight weeks.

First Follow-up Appointment 

The first follow-up after the septal myectomy surgery is usually seven to ten days after discharge from the hospital. During this appointment:

1. The doctor evaluates the sutures and the surgical site for wound healing and signs of infection.

2. Medications prescribed at the time of discharge are evaluated.

3. If the doctor feels the wound is healing well, suture removal may be performed during the first follow-up appointment.

4. Routine diagnostic tests may be performed to ensure the patient is recovering well.

Risks do exist, but septal myectomy is generally considered a safe and effective procedure when performed by skilled surgeons. These risks include:

1. Bleeding: There may be some bleeding, as with any surgical procedure, which is usually controlled during surgery.

2. Infection: It can be possible at the surgical site. However, antibiotics are administered to minimise this risk.

3. Heart Rhythm Issues: Temporary or, rarely, persistent irregular heart rhythms can occur but are closely monitored and managed.

4. Blood Clots: Clot formation is a risk, particularly in the legs, but preventive measures are taken, such as blood-thinning medications.

5. Stroke: In rare cases, a clot can travel to the brain, causing a stroke.

When is Consultation with a Doctor Needed? 

Patients are requested to keep track of their recovery and report any abnormal symptoms, as they could be a sign of complications. Some of these to look out for include:

1. Fever over 100.4 degrees F

2. Redness, swelling or warmth around the incision site

3. Pus or bloody discharge

Patients are advised to report any of these abnormal symptoms to their doctor at the earliest.

Some procedures are required to be performed at the earliest to avoid long-term implications. Delaying septal myectomy can lead to the following:

1. Progression of Symptoms: Delaying the procedure can lead to worsening symptoms such as chest pain, shortness of breath, and fatigue.

2. Reduced Quality of Life: Prolonging the surgery may result in a decreased ability to perform daily activities and a reduced overall quality of life.

3. Heart Damage: With time, the heart muscle can become more damaged due to the ongoing strain caused by the obstruction.

4. Increased Risk of Complications: Delayed surgery can increase the risk of heart-related complications like irregular heart rhythms, heart failure, and blood clots.

5. Surgical Complexity: In some cases, postponing the procedure can make the surgery more complex and potentially less effective.

6. Limited Treatment Options: Continued delay may limit the effectiveness of non-surgical treatments and require a more invasive approach.

The cost of septal myectomy in India varies from ₹ 3,00,000 to ₹ 5,00,000. Several factors influence the cost of this procedure, such as:

1. Severity of the Condition: The extent to which HCM affects you can influence the total cost; more severe cases may require more extensive procedures.

2. Clinic or Hospital Selection: The choice of the facility where the surgery is conducted can impact costs, with larger or more prestigious clinics or hospitals potentially charging more.

3. Location: Geographical location plays a role as living costs and healthcare expenses can vary significantly between cities and regions.

4. Patient's Age: Younger patients may have differing physiological considerations, affecting the complexity and cost of the procedure.

5. Post-Surgery Complications: Any complications that arise after the surgery, requiring additional treatment, can contribute to the overall cost.

Septal myectomy is an effective long-term treatment for hypertrophic cardiomyopathy and has improved symptoms in most patients. This type of open-heart surgery is performed in individuals for whom medications have not shown the desired results. Septal myectomy surgery has a quick recovery time. Most individuals who undergo this procedure can go home five to seven days after the procedure.

 If you or your loved one are living with hypertrophic cardiomyopathy, it is essential to get it treated at the earliest. HexaHealth is a one-stop platform for all your healthcare needs. We can help you find the top specialists in your city and any other medical information you need about your condition. Contact a HexaHealth expert today!

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