Extended Myectomy for Apical Hypertrophic Cardiomyopathy: A Case Report

Abstract BackgroundApical hypertrophic cardiomyopathy is a variant of hypertrophic cardiomyopathy that predominantly affects the left ventricle apex and rarely involves the right ventricular apex or both apexes. Traditional treatment for apical hypertrophic cardiomyopathy is heart transplantation. Although surgical myectomy approaching the apex has been available for decades, its safety and accuracy greatly depend on the surgeon’s skills and experience.Case presentationThe first case is of a 63-year-old man with apical hypertrophic cardiomyopathy in whom a preoperative contrast computed tomography revealed apical hypertrophy and complete apical cavity obliteration. The patient underwent extended myectomy. The inside of the apex cavity was filled with abnormal muscles. Using the transaortic approach, the location of the bilateral papillary muscle was confirmed, which provided the required orientation. The abnormal muscle mass was successfully resected, and postoperative end-diastolic volume was extremely increased. The second case is of a 43-year-old man with an apical left ventricular aneurysm and mid- hypertrophic cardiomyopathy obstruction. The thin-walled apical aneurysm contained a large apical-basal band. After detecting the bilateral papillary muscle, mid-ventricular myectomy was performed from the apex. During postoperative catheterization, there was no pressure gradient between the left ventricle and aorta.ConclusionsWe reviewed two cases of apical hypertrophic cardiomyopathy, efficiently treated using extended apical myectomy. Although apical myectomy is an uncommon procedure, the cases presented herein show that it can successfully manage apical hypertrophic cardiomyopathy. However, it is important to secure the postoperative left ventricular end-diastolic volume.