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What is a Myomectomy?

Hypertrophic obstructive cardiomyopathy (HOCM) is a condition in which the left ventricle becomes too thick, gradually resulting in severe diastolic dysfunction. As this process worsens, the left ventricle becomes stiffer and loses its ability to relax and fill properly during diastole. Less often, the septum thickens out of proportion to the rest of the left ventricle, setting up the potential for obstructive physiology. The mitral valve can then interfere with the surge of ventricular blood flow during systolic contraction and result in so-called systolic anterior motion (SAM) of the mitral valve. We strongly believe that alleviation of outflow tract obstruction in patients with HOCM also requires attention to the mitral valve. The position of leaflet coaptation is altered to exaggerate more posterior coaptation, reducing the potential for SAM, not uncommon after isolated septal excision.

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Myomectomy patient case study

Douglas Bourne is a 66-year-old petroleum engineer working in Kazakhstan who was referred to Sequoia Hospital with symptoms experienced with changes in altitude and level of exertion, consisting of worsening dizziness, hypotension, and chest tightness. Echocardiography revealed HOCM, with significant subaortic gradient, and SAM, associated with severe mitral regurgitation. Coronary angiography also revealed an aberrant right coronary artery originating adjacent to the left main coronary ostia and coursing intramurally along the anterior wall of the aorta.

The right surgery at the right time

The operation was performed through a standard sternotomy. The right coronary artery was detached proximally and directly reimplanted to the right aortic wall sinus of Valsalva. An extensive left ventricular septal myomectomy was performed beneath the right coronary cusp. Finally, because the mitral valve was sufficiently abnormal, with redundancy of both the anterior and posterior leaflets, the posterior leaflet was plicated along the posterior annulus. This repair was secured with a partial flexible annuloplasty band. Following this procedure, he had no evidence of subaortic obstruction.

Surgical intervention

When Douglas Bourne scheduled his initial visit with Luis Castro, MD in September 2011, his heart condition and high blood pressure had put him at high risk for heart attack and stroke. For someone as active as Doug, this meant he put himself at risk on a daily basis. “Basically my heart was not discharging the blood properly. Under high-activity conditions, I was putting myself at extreme risk. I could walk on flat surfaces without a problem, however as soon as I was going up stairs or up slopes, it was very difficult,” states Doug.

Doug had his first stress test in 2008, where his heart condition was discovered. In December 2011, Doug had another stress test and appointment with his cardiologist. “His words were 'now,' the operation had to be done now,” Doug explains. Two years after his surgery, Doug returned to visit his cardiologist. “I was back in San Jose to visit my cardiologist for a follow-up visit and stress test. He offered one word: 'Wow.' The stress test results were the best he had seen,” Doug says.

At 66, Doug works full time and is enrolled in an online master’s degree study program. He attributes his recovery to his self-motivation and positive attitude. “Work and mental attitude is the key. I am fortunate to have been an active person and I am very self-motivated, with a positive attitude, which was key to my recovery,” says Doug.

Doug found the staff at Sequoia Hospital very professional and confident. While he was recovering from his surgery at Sequoia Hospital, Doug’s nurses encouraged him to ambulate with assistance. He had been very active and fit prior to surgery, helping expedite his recovery. By the time he was discharged from the hospital, he was walking more than a half-mile twice daily. While recovering, he worked walking into his daily routine. Doug now completes 5-kilometer walks in less than 50 minutes on the weekends, sometimes on both Saturday and Sunday. “I am walking four to five times a week and have now completed back-to-back 5-kilometer walks,” says Doug.

In addition to 5-kilometer weekend walks, Doug has also returned to one of his favorite activities: ice skating. “I am ice skating, which I love. I recently managed a solid 1.5 hours with minor rests, but other than that, continuous skating,” Doug states proudly.

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