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Transatrial-transmitral Septal Myectomy For Hypertrophic Obstructive Cardiomyopathy In Children
Sertac Cicek1, Cagla Canbay Sarilar, MD1, Ahmet H. Arslan, MD2, Cem Ariturk, MD3.
1Istanbul University Istanbul Faculty of Medicine, Department of cardiovascular Surgery, Istanbul, Turkey, 2Anadolu Medical Center Department of Cardiovascular Surgery, Istanbul, Turkey, 3Liv Vadistanbul Hospital Section of Cardiovascular Surgery, Istanbul, Turkey.

Objective(s): Although accepted as the gold standard for HOCM, transaortic septal myectomy might be a suboptimal approach in children due to small aortic valve orifice limiting the exposure. Transatrial-transmitral myectomy provides an alternative approach in children. This study sought to assess the effectiveness and outcome of transatrial transmitral approach.
Methods: 19 children underwent transatrial-transmitral septal myectomy for symptomatic obstructive hypertrophic cardiomyopathy between 2010 and 2022. Ages at operation ranged from 3 months to 14 years. All had systolic anterior motion with moderate to severe mitral regurgitation.
Results: The peak left ventricular outflow gradient decreased from 120 28 to 14 9 mm Hg (p<0.01). All patients left OR with no SAM and less than mild mitral regurgitation. There was one early death in a patient with Noonan syndrome who underwent a biventricular myectomy, One patient required a permanent pacemaker. One patient lost to follow-up and no patient required a reoperation during the follow-up period.
Conclusions: Transatrial-transmitral myectomy provides a safe and effective alternative to transaortic myectomy in children.


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