MODIFIED TECHNIQUE OF MANAGEMENT FOR DISCRETE AND DIFFUSE SUBAORTIC STENOSIS

Abstract

We report a new original method of management for subaortic stenosis. When performing myectomy from the transaortic access of Morrow, the significant problem is poor visualization of the interventricular septum. The key to the successful implementation of the septal myectomy is achieving sufficient length, width and depth of resection of the hypertrophied interventricular septum. The authors introduced a new modification called “fixed needle technique” in order to visualize the entire region of septal hypertrophy and achieve safe extended myectomy of ventricular hypertrophy. Three needles of 21 gauge (0.8 mm) are introduced into the interventricular septum immidiately under the fibrous ring of the aortic valve, and reache the distal part of the hypertrophic portion. The right and left needles limit the width of resection and its depth is limited with the central needle. Each needle is a marker for the width, length and depth of resection. Needles allow to fix the interventricular septum and improve exposure of septal hypertrophy. The described technique allows to perform the required myectomy of the same thickness. The technique provides high-quality visualization of the interventricular septum and adequately removes hypertrophied part of myocardium in challenging patients with discrete subaortic stenosis and idiopathic hypertrophic cardiomyopathy.

Keywords

• subaortic stenosis
• hypertrophic obstructive cardiomyopathy
• modified technique of subaortic myectomy