Hypertrophic Cardiomyopathy Surgery | Procedures and Risks

livewell
June 22, 2024
Eric kent

What is Meant by Hypertrophic Cardiomyopathy?

It is a condition that affects the left ventricle. The left ventricle is the main chamber of the heart for pumping. In this condition, the left ventricle thickens and stiffens. Due to this, the heart is unable to pump the blood properly. The cause of hypertrophic cardiomyopathy is genetic mutations and it can be inherited from a close member of the family suffering from HCM. Hypertrophic cardiomyopathy can result in serious conditions of health like atrial fibrillation, stroke, heart failure, and ventricular arrhythmias. However, the symptoms of hypertrophic cardiomyopathy vary among individuals. Some people might be asymptomatic. The most common symptoms are fatigue, heart murmur, dizziness, chest pain, shortness of breath, swelling of feet, neck, ankles, and abdominal region, irregular heart rhythm, etc.

What Are The Types of Hypertrophic Cardiomyopathy?

It is divided into many types. Some of the main types of Hypertrophic Cardiomyopathy are as follows:

Obstructive Hypertrophic Cardiomyopathy

This is the most common type. This condition involves the thickening of the wall between the right and left ventricles, obstructing blood flow from the ventricle to the aorta.

Non-Obstructive Hypertrophic Cardiomyopathy

In this type of Hypertrophic Cardiomyopathy, the muscles of the heart thicken but it doesn’t obstruct the blood flow.

Concentric Hypertrophic Cardiomyopathy

This is a rare form of Hypertrophic Cardiomyopathy. In this condition, the entire wall of the left ventricular thickens uniformly however, there is no specific hypertrophy pattern. This form of Hypertrophic Cardiomyopathy might be associated with other conditions or diseases.

Localized or Segmental Hypertrophic Cardiomyopathy

In this condition, thickening occurs in a localized region of the heart muscle. The impact varies depending on the extent of thickness and location.

Midventricular Hypertrophic Cardiomyopathy

This involves thickening in the middle portion of the walls of the ventricle. This might result in blocking in the mid-ventricle. The symptoms can be severe.

How Can Hypertrophic Cardiomyopathy be Diagnosed?

It can be diagnosed by following procedures.

Medical History and Physical Exam

The healthcare provider will ask detailed questions regarding the medical history of an individual who might be suffering from Hypertrophic Cardiomyopathy. The healthcare provider will look for signs and symptoms associated with Hypertrophic Cardiomyopathy.

Magnetic Resonance Imaging

This detects any thickness of the wall of the left ventricle by providing detailed images.

Angiography of the Coronary Arteries

It provides images of the coronary arteries, to look for any blockages or obstructions.

Echocardiogram

In this diagnostic test, ultrasound waves are used for taking heart pictures. It helps to evaluate the blood pumping of the heart and the thickness of the muscles of the heart.

Electrocardiogram

ECG is the test that detects abnormal rhythms of the heart. It also records the electric impulses in the heart.

Holter monitoring

It is a portable ECG device that monitors the heart during daily activities.

Electrophysiology study

In this diagnostic test, an electrophysiologist measures the electrical activity of the heart by inserting a thin tube through a blood vessel that reaches the heart.

Genetic testing

This involves testing the blood for the evaluating genes involved in Hypertrophic Cardiomyopathy. The healthcare specialist determines whether an individual should go for genetic testing or not. Besides this, it requires proper counseling, to help an individual understand the method and what could be the possible outcomes.

Stress test

It involves an exercise test which is done to measure the function of the heart during physical activities like walking, cycling, running, etc.

How Can Hypertrophic Cardiomyopathy be Treated?

The main aim of treatment is to ease symptoms and prevention of sudden cardiac death in high-risk individuals. The type of treatment depends upon the severity of symptoms. Some treatment options for Hypertrophic Cardiomyopathy are:

Medications

Certain medications play a role in treating hypertrophic cardiomyopathy. Some of them are:

Beta-blockers like atenolol, metoprolol, etc.
Calcium channel blockerssepta like verapamil, diltiazem, etc.
Blood thinners like warfarin, apixaban, etc. Blood thinners prevent the formation of blood clots in case an individual has atrial fibrillation.
Medication for heart rhythms like disopyramide, amiodarone, etc.

Surgeries

Different surgeries can help in the treatment of Hypertrophic Cardiomyopathy and its symptoms

Changes in Lifestyle

Adopting a healthy and balanced lifestyle can help in improving cardiovascular health. Individuals suffering from Hypertrophic Cardiomyopathy are advised not to engage in extensive physical activities. Consuming a healthy and nutritious diet helps in managing weight and improves cardiovascular health.

Hypertrophic Cardiomyopathy Surgery, Types and Procedure

The surgical options for treating Hypertrophic Cardiomyopathy and its symptoms are:

Septal Myectomy

In case medicines are ineffective, septal myectomy might be recommended. It is an open-heart surgery that involves the removal of thick and overgrown walls between the chambers of the heart. This wall is known as the septum. The surgery helps improve blood flow thus reducing backward blood flow through the mitral valve. Different approaches can be used for doing septal myectomy. It depends on the area of the thickened muscles of the heart. For instance, in apical myectomy, the thickened muscle from near the tip of the heart is removed by surgery.

Procedure

This procedure starts with giving general anesthesia to the patients. The surgeon made a midline incision to access the heart. The patient is connected to a bypass machine, this heart-lung bypass machine temporarily takes over lungs and heart functions during the surgical procedure. Then, a cardioplegic solution is used to stop the heart temporarily, this is done to protect the heart during surgery. Meanwhile, the surgeon opens the pericardium and identifies the thickened wall causing blockage of blood flow from the left ventricle. The surgeon then carefully removes the part of the thickened septum that causes obstruction. Lastly, the surgeons evaluate the effectiveness of surgery by checking the changes in the dynamics of blood flow and heart pressure. After completion of septal myectomy and confirming control of bleeding, the chest and sternum are closed by using wires.

Septal Ablation

This procedure involves the use of alcohol to cause the shrinking of the thickened muscle of the heart. A catheter which is a long, thin tube is placed into an artery, this artery supplies blood to the affected area. Alcohol flows through the catheter. This induces a controlled heart attack, reduces the septal wall’s thickness and relieves blockage or obstruction.

Procedure

The procedure starts by giving general anesthesia to the patients. In this procedure, at first, the catheter is inserted into the femoral artery and guided to reach the coronary artery that supplies blood to the thickened septum. This is done using X-ray imaging. A catheter is positioned carefully. This procedure might involve the administration of contrast dye by using injection. The purpose of the dye is to visualize the flow of blood and identify the optimal area for the injection of alcohol. Once the site is identified, a small volume of pure alcohol is injected into an artery by using a catheter. The alcohol injection causes localized tissue death in the septum, the mechanism is disruption of the blood flow to overgrown muscle tissue. The patient is closely monitored throughout the whole process. The specialist assesses the reduction in thickness of the septum and changes in blood flow dynamics to ensure the procedure’s effectiveness. The patient is closely observed for several hours for confirmation of stability and no complications.

Implantable Cardioverter-defibrillator

ICD is a device placed under the collarbone skin. It helps in the detection and treatment of irregular heart rhythms and treats irregular heart rhythms by sending out high or low-energy shock waves. Can help in the prevention of sudden cardiac death.

Procedure

The procedure starts with administering local anesthesia to the patient. The surgeon cuts the collarbone. The next step is the placement of the device under the skin. The surgeon then threads the lead through a vein into the heart. This is for monitoring the heart’s electrical activity and to give shocks in case of abnormal rhythms. The next step is the connection of the lead with the ICD device. The surgeon ensures the proper functioning of the device. Lastly, the surgeon closes the cut by using sutures. This entire procedure takes a few hours.

Cardiac Resynchronization Therapy Device

CRT is a device, used for the treatment of individuals suffering from Hypertrophic Cardiomyopathy. It helps in the synchronized squeezing of the heart chambers, thus allowing the heart to work efficiently.

Procedure

First, the surgeon gives anesthesia to the patient. Then the surgeon cuts the chest. The next step is the placement of the CRT device under the skin. The surgeon inserts the lead through a vein and it reaches the heart. The surgeon positions the wire in different parts of the heart, for synchronizing the contraction of the heart. After this, the surgeon connects the wire to the CRT device. Then he/she closes the cut with the help of stitches, after ensuring the device’s proper functioning. This procedure requires a few hours.

Ventricular Assist Device

This device is rarely used for the treatment of Hypertrophic Cardiomyopathy. It helps the flow of blood through the heart.

Procedure

First, the surgeon gives anesthesia to the patient. He/she cuts the chest. Then implant VAD in the chest properly. The surgeon closely monitors the patient after surgery, to ensure the device’s proper functioning and look for any complications.

Risks Associated with Hypertrophic Cardiomyopathy Surgery

Septal Myectomy Risks

The risk of complications due to septal myectomy is rare. Some risks associated with septal myectomy are:

Infection at the site of surgery or within the chest cavity. This can result in severe systemic infections.
Bleeding during or after surgery. The patient might need extra surgical interventions and blood transfusions.
Arrhythmias that can result in irregular heart rhythms.
It can result in heart block. Individuals suffering from heart block require the implantation of a permanent pacemaker device.
Myocardial infarction during or after the surgery.
Some respiratory, structural, renal, and neurological complications like pneumonia, aortic valve damage, kidney injury, brain stroke, etc.
Other risks associated with septal myectomy are thromboembolism (formation of blood clots and traveling of blood clots to other body parts resulting in complications like pulmonary embolism).

Septal Ablation Risks

Some of the risks associated with septal ablation are:

Arrhythmias result in irregular heart rhythms.
Complete Blocking of Heart.
Risk of an infection.
Bleeding
During septal ablation coronary artery can be damaged, resulting in a heart attack.
Complications at the site of catheter insertion like hematoma, infection, or bleeding.
Accumulation of fluid or blood in the pericardial sac results in compressing the heart and causes impairment of the heart’s function. This complication is rare but it requires immediate treatment.

Implantable Cardioverter-Defibrillator Risks

It can be life-saving, but there are certain risks and complications associated with this device. Some of the main risks are:

Infection at the site where the device is placed. In case of severity, removal of the device may be required.
Bleeding which might require an additional surgical procedure.
Hematoma.
Cardiac Risks like arrhythmias and perforation.
Thrombosis.
Allergic or adverse reactions due to anesthesia.

Cardiac Resynchronization Therapy Device Risks

CRT carries certain potential risks and complications. Some of them are:

Infection at the site where the device is placed. Like ICD it also might require removal in case of severity.
Bleeding
Hematoma
Pneumothorax can result during the placement of the wire. It is a condition in which air is leaked into the space between the chest wall and the lungs.
Pericardial Effusion.
Cardiovascular risks like heart block, heart attack, etc.

Ventricular Assist Device Risks

The risks associated with ventricular assist devices are:

Infection at the surgical site.
Bleeding during or after the surgical process.
Hemolysis is a condition involving the destruction of RBCs (red blood cells). This can result in anemia or other complications.
Thrombosis.
Failure of the right ventricle.
Arrhythmias.
Increased gastrointestinal bleeding risk.
Kidney dysfunction, particularly in patients with already existing kidney conditions.

Heart Transplant Risks

Heart transplant is life-saving but it can result in some risks and complications such as:

Infection at the site of surgery.
Bleeding during surgery or after surgery.
Immune system rejection, as the immune system may recognize the donor’s heart as a foreign object and attack it. This condition requires the use of immunosuppressive supplements or medications.
Obesity
Other organs like the kidney or liver might be affected by the surgery or post-transplant medications.
Blood clot formation leads to stroke, pulmonary embolism, or heart attack.
The use of immunosuppressive medication post-transplant can lead to diabetes and hypertension.

Recovery from Hypertrophic Cardiomyopathy Surgery

The recovery depends upon the type of Hypertrophic Cardiomyopathy surgery performed. After Hypertrophic Cardiomyopathy surgery patients are typically admitted in intensive care units for one to two days. However, they are closely monitored for any complications or risks associated with surgery and are administered with medications to relieve pain and discomfort. Some patients might require temporary oxygen support or mechanical ventilation. During their hospital stay, there is a gradual increase in physical activities such as walking, light exercises, etc. Blood test, echocardiograms, and electrocardiograms continuously monitor their heart function.

After five to ten days of the surgery, patients are free to go home. Patients after Hypertrophic Cardiomyopathy Surgery must avoid heavy lifting and extreme physical activities. Furthermore, they must keep the surgical site clean and dry and should self-monitor their surgical sites to prevent infection and contamination. Patients must follow the prescription and take medication on time. Regular follow-ups are necessary. For long-term recovery, the patient should participate in a cardiac rehabilitation program and lifestyle changes. These guidelines and consultation with health care professionals result in proper recovery after Hypertrophic Cardiomyopathy surgery.

Conclusion

To sum up, Hypertrophic Cardiomyopathy is a condition that results in thickening and stiffening of the left ventricle. This causes the improper pumping of blood. There are different types of Hypertrophic Cardiomyopathy such as Obstructive, Non-obstructive, Concentric Hypertrophic Cardiomyopathy, etc. The diagnostic procedures of Hypertrophic Cardiomyopathy include ECGs, MRIs, angiography, stress tests, etc. The treatment involves the use of certain medications and surgeries.

Hence, the surgical options include septal myectomy, septal ablation, heart transplantation, etc. Some risks and complications are also associated with each type of surgery like allergic reactions, infections, bleeding, etc. An individual can properly recover after acting upon the guidelines of recovery provided by the healthcare provider. Also, with advancements in surgical treatments, there is hope for patients to recover from Hypertrophic Cardiomyopathy and live their lives to the fullest.

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What is Hypertrophic Cardiomyopathy?

It is a disease that affects the left ventricle. In this condition, the left ventricle thickens and stiffens. Due to this, the heart is unable to pump the blood properly.

What are the treatment methods for Hypertrophic Cardiomyopathy?

It can be treated via the use of certain medications and surgical procedures.

What is the diagnostic procedure for Hypertrophic Cardiomyopathy?

The diagnosis includes ECGs, MRIs, stress tests, angiography, etc.

What are the types of Hypertrophic Cardiomyopathy Surgery?

The main types are septal ablation, septal myectomy, and heart transplantation.