Echocardiography Guidance and Evaluation of Myocardial Septal

Myectomy with a Novel Device

Magnus Dencker

and Henrik Bjursten

Department of Medical Imaging and Physiology, Skåne University Hospital, Malmö, Sweden

Department of Thoracic Surgery, Skåne University Hospital, Lund, Sweden

Keywords: Hypertrophic Obstructive Cardiomyopathy, Myectomy, Echocardiography.

Abstract: Hypertrophic obstructive cardiomyopathy represents a significant clinical problem. The objective with this

investigation was to address if echocardiography guide and monitor myocardial septal myectomy with a

novel device. An experimental porcine model was used. The findings were that echocardiography can

successfully be used to guide a novel procedure for minimally invasive surgical myectomy. Moreover,

echocardiography can be used to hemodynamically monitor this procedure. Finally, echocardiography can

be used to evaluate the result of the myectomy.

1 INTRODUCTION

Hypertrophic obstructive cardiomyopathy with

dynamic left ventricular outflow tract obstruction

often leads to progressive heart failure, and also

sudden death in some patients (Maron, 2013).

Surgical intervention with myectomy has, in the

past, been the primary strategy for treatment (Maron,

2011). Alcohol septal ablation has in recent years

been introduced as a less invasive alternative (Alam,

2006). The efficacy of this procedure has been

questioned (Yacoub, 2005). We performed the first

test ever of a novel surgical device for minimally

invasive surgical myectomy (Septulus). The

objective was to address following questions; 1)

Could echocardiography guide this procedure? 2)

Could echocardiography be used to

hemodynamically monitor the procedure? 3) Could

echocardiography be used to evaluate the result of

the myectomy?

2 METHODS

An experimental porcine model was used. Two adult

pigs were anesthetized and minimally invasive

surgical myectomy was performed with the

Septulus, introduced into the left ventricle from the

apical approach. Echocardiography examinations

were performed with CX-50 cardiac ultrasound

system with S5-1 probe (Philips Medical Systems,

Best, The Netherlands). The porcine equivalent of

parasternal long-axis was used to visualize septum

and the left ventricular outflow tract.

3 RESULTS

Both the Septulus and the septal portion of the left

ventricle could successfully be imaged in both pigs

(figure 1). The procedure was successfully guided

by the echocardiography images. Moreover, stroke

volume could be calculated from pulsed Doppler

recordings obtained in the left ventricular outflow

tract (figure 2). The results from the myectomy

could be recorded post-operatively (figure 3).

Figure 1: Shows the divice at the septum.

Dencker, M. and Bjursten, H..

Echocardiography Guidance and Evaluation of Myocardial Septal Myectomy with a Novel Device.

Figure 2: Shows Doppler recordings.

Figure 3: Shows the results from the Myectomy post-

operatively.

4 CONCLUSION

Echocardiography can successfully be used to guide

a novel procedure for minimally invasive surgical

myectomy. Echocardiography can be used to

hemodynamically monitor this procedure.

Echocardiography can be used to evaluate the result

of the myectomy.

REFERENCES

Alam M, Dokainish H, Lakkis N. Alcohol Septal Ablation

for Hypertrophic Obstructive Cardiomyopathy: A

Systematic Review of Published Studies. J Interven

Cardiol. 2006;19:319-27.

Maron BJ, Maron MS. Hypertrophic cardiomyopathy.

Lancet. 2013:381:242-55.

Maron BJ, Yacoub M, Dearani JA. Controversies in

cardiovascular medicine. Benefits of surgery in

obstructive hypertrophic cardiomyopathy: bring septal

myectomy back for European patients. Eur Heart J.

2011:32:1055-8.