Purpose
Given the development of left bundle branch block in many HOCM patients after Morrow myectomy, patients who develop right bundle branch block after alcohol septal ablation (ASA) have a higher likelihood of complete AV block after surgery. A new technique of HOCM surgical correction without damages to the heart conduction system in patients with severe hypertrophy after unsuccessful ASA was proposed.
Methods
We present seven cases of HOCM surgical correction after failed ASA in symptomatic patients (mean NYHA Class 3,0) with obstruction in the left ventricular midcavity. The excision was performed from the conal part of the right ventricle in middle part of the right side of IVS. Conceptually this approach offers a number of advantages: it affords the excision of the asymmetrically hypertrophied area of the ventricular septum without penetration into the left ventricle cavity, it avoids mechanical damage to the heart conduction system and aortic valve, and for the surgeon it improves visual inspection of the area to be resected. The follow-up period was 35±8 months.
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