SURGICAL OPTIONS

Surgical options are primarily used to alleviate more serious symptoms that cannot be addressed completely by medication. Children with obstructive hypertrophic cardiomyopathy (HOCM) can develop a severe thickening of the heart muscle, which blocks the flow of blood out of the lower heart chambers (ventricles). A septal myectomy may be recommended to reduce the thickness of the heart muscle and improve blood flow from the heart. Children with dilated cardiomyopathy may need surgery to repair or replace a leaky mitral valve affecting their heart function.

Septal Myectomy and Ablation

Septal myectomy is a surgical procedure that involves removing excessive muscle tissue from the heart. While septal myectomy is effective in controlling symptoms of heart failure, it does not stop cardiomyopathy from progressing nor does it correct for arrhythmia. Septal myectomy is considered open-heart surgery and involves recovery time both in the hospital and at home.

Alcohol septal ablation is an alternative procedure performed in adults with hypertrophic obstructive cardiomyopathy. A small portion of the thickened heart muscle is destroyed by injecting alcohol through a long, thin tube (catheter) into an artery supplying blood to the heart. This procedure is generally not recommended for young children because of the increased risk of complications from their smaller heart size and narrower blood vessels. Radiofrequency catheter ablation is a procedure that is being investigated for children. This type of ablation uses heat to reduce the thickness of the abnormal heart tissue.

Mitral Valve Repair or Replacement

In some patients with dilated or hypertrophic cardiomyopathy, enlargement of the heart may affect the mitral valve, which connects the upper heart chamber (atrium) to the lower heart chamber (ventricle). Leakage may occur between the heart chambers (mitral regurgitation) and cause the heart to pump less efficiently. Mitral valve repair or replacement can improve the function of the heart muscle and lessen the symptoms of heart failure.