Septal Myectomy

Septal myectomy is a type of open-heart surgery (large incisions of 8-10 inches long / involves dividing the breast bone / general anesthesia) performed to reduce heart muscle thickening. The thickening is called hypertrophic cardiomyopathy (HCM) and most commonly occurs at the septum. The septum separates the heart’s left and right ventricles (lower chambers). If the septum becomes too thick, the passageway to the aorta (body’s main artery) becomes very narrow. This limits or blocks the flow of blood and starts causing symptoms such as chest pain, shortness of breath, and syncope (fainting). In many cases, medicines are enough to relieve these mild symptoms. If not, your doctor will decide on one of two procedures: alcohol septal ablation or septal myectomy. The type of procedure chosen will vary according to your particular health condition.

How to prepare for the procedure

Before the procedure, your doctor and treatment team will explain to you what to expect before, during and after the procedure and potential risks of the procedure. Other recommendations include:

Talk to your doctor about

  • All medications, herbal products and dietary supplements you are currently taking and ask for their recommendations about each.
  • Diabetes and how to adjust your medicine on the day of the procedure
  • Radiation exposure, especially for those that are pregnant
  • Any allergies to medicines, latex, tape, iodine, and anesthetic agents
  • Any history of bleeding disorders
  • Any implanted device (e.g. pacemaker or ICD)
  • Any body piercings on your chest or abdomen

Other suggestions

  • Eat a normal meal the evening before the procedure. However, do not eat, drink or chew anything after midnight before your procedure. If you must take medications, only take them with sips of water.
  • Leave all jewelry at home
  • Remove all makeup and nail polish
  • Wear comfortable clothing when you come to the hospital.
  • If you normally wear dentures, glasses, or hearing devices at home, plan to wear them during the procedure.

What to expect before the procedure

Before the procedure, your doctor might perform a variety of tests, including:

Diagnostic tests and procedures

What to expect during the procedure

A septal myectomy usually takes 3 to 6 hours, but the preparation and recovery time add several hours. The procedure is usually performed in the cardiothoracic operating room (OR). Check with your doctor about the details of your procedure. In general:

  • You will change into a hospital gown.
  • Prior to starting the procedure, you will receive a local anesthetic. Once you are sedated, your doctor may insert a breathing tube through your throat into your lungs and connect you to a ventilator. This will breathe for you during surgery.
  • Your doctor will administer general anesthesia (will make you feel sleepy).
  • The procedure begins when your doctor cuts the breastbone (sternum) in half and spreads both halves to gain access to your heart (open-heart surgery).
  • For this type of surgery, your heart must be still. Prior to doing so, your doctor will place tubes into your heart so that blood can be pumped through your body by use of a heart-lung machine. This machine takes over for the heart by replacing the heart’s pumping action and the lungs by adding oxygen to the blood.
  • Once the blood has been diverted into the bypass machine for pumping, your doctor will then stop the heart by injecting it with a cold solution.
  • When the heart has been stopped, your doctor will begin to remove the excess amount of the thickened septal wall with the use of special tools.
  • After this process is complete, the doctor will make sure everything is working properly. Once checked, the doctor will let the blood circulating through the bypass machine back into your heart.
  • If your heart is not restarting after the procedure is complete, a mild electric shock may be used to restart it.
  • Your doctor may also put temporary wires for pacing into your heart. These wires can be attached to a pacemaker, if needed, during the initial recovery period.
  • Once the procedure is complete, the machine will be turned off. The tubes will be removed and the sternum will be sewn together with the use or sutures or surgical staples.

Septal Myectomy

Medical Illustration Copyright © 2019 Nucleus Medical Media, All rights reserved.

What to expect after the procedure

After the procedure, you will be taken to the cardiothoracic intensive care unit (CTICU) for further observation for 5 to 7 days. Other recommendations include:

General guidelines

  • The breathing tube is removed when you wake up from anesthesia.
  • Diet is started the day after surgery with liquids, and quickly advanced to solids as tolerated.
  • Ambulation is started on the first or second day of surgery.
  • Urine catheters and drainage tubes (chest tubes) are removed after 24 to 48 hours.
  • If you have pacing wires in your heart, he or she will remove those too.
  • Nurses, respiratory therapists, and physical therapists will work with you as you begin physical therapy and breathing exercises.
  • Your doctor will give you instructions to follow during your recovery.
  • A cardiac rehabilitation program may also be suggested.
Saint Barnabas Medical Center
94 Old Short Hills Road
Livingston, NJ 07039
(973) 322-5000
View
Newark Beth Israel Medical Center
201 Lyons Avenue at Osborne Terrace
Newark, NJ 07112
(973) 926-7000
View
Jersey City Medical Center
355 Grand Street
Jersey City, NJ 07302
(201) 915-2000
View
Robert Wood Johnson University Hospital
1 Robert Wood Johnson Place
New Brunswick, NJ 08901
(732) 828-3000
View

Septal Myectomy Treatment & Care

offered at these locations in your neighborhood

View All Locations