Do you sometimes feel like you have a feeling of heaviness in your chest, a feeling of tightness in your chest, or a feeling of faintness when you walk up a flight of stairs, run for a bus, or do you feel like you're about to faint? You may think that this is normal fatigue, but sometimes it could be a heart condition called Hypertrophic Cardiomyopathy . Don't worry, today we're talking about a very successful surgery called Septal Myectomy , which is performed as a treatment for this condition. Just like explaining it to a friend, let's talk about everything in simple terms.
First, let's see what this so-called Hypertrophic Cardiomyopathy is?
To understand this simply, let's compare our heart to a water pump. The job of the pump is to draw water through pipes and send it throughout the house. Our heart is like that, its main job is to pump blood throughout our body.
There are four main chambers in our heart.
- We call the two upper chambers the atria (right and left).
- We call the two chambers below the heart ventricles (right and left).
To be precise, there's a wall of muscle that separates the left and right chambers below. We call this the septum . In hypertrophic cardiomyopathy, this septum, that is, this wall in the middle of the heart, becomes abnormally thicker than normal.
Imagine what happens if a pipe in that water pump gets clogged? The space for water to flow is reduced, and the pump has to work very hard to push the water out. That's what happens here too. This septum thickens and protrudes into the left ventricle. Then the way for blood to flow out of the left ventricle, the main chamber that pumps blood from the heart to the body, is blocked. Because of this, the heart has to work much harder (overwork) than usual to pump the amount of blood needed by the whole body.
This condition can be congenital heart disease for some people. This means that they are born with this problem. For others, it can develop later in life.
So what is this surgery called Septal Myectomy?
Simply put, Septal Myectomy is an open-heart surgery in which a cardiac surgeon cuts out and removes an abnormally thickened portion of the heart wall (septum).
Just like clearing the road by removing the blockage in the water pipe, after this surgery, the obstruction to the blood flow in the heart is removed. Then the heart can easily pump blood throughout the body without any obstruction. This is the main purpose of this surgery.
Who is this surgery recommended for?
Usually, a doctor does not recommend this surgery right away. They first try to control the symptoms by giving medications. However,
- For those whose symptoms (such as shortness of breath, chest pain) cannot be controlled with medication.
- For those who have a very thick wall on the left side of the heart, causing significant obstruction to blood flow .
- Women with Hypertrophic Cardiomyopathy who are planning to become pregnant (even if the symptoms are not severe, this surgery may be recommended as a precautionary measure as the heart is put under extra strain during pregnancy).
It is in cases like this that the doctor will talk to you and decide that this surgery is the best option.
What should you do before surgery?
Your doctor will give you all the instructions you need before the surgery. There's nothing particularly major to do, but there are some things you should be aware of.
- If you are taking any medications, such as blood thinners , you may be asked to stop taking them a few days before the surgery.
- If you are a smoker , it is very important to try to quit before surgery, as smoking interferes with the healing process.
In addition, several tests will be performed to accurately assess the condition of your heart. These are done to see how ready your heart is before surgery.
| Test | Simply put, what do you do with it? |
|---|---|
| Blood Tests | Things like your general health, kidney and liver function are checked. |
| Chest X-ray | Observe the shape and size of the heart and lungs. |
| Electrocardiogram (ECG) | The heart's electrical activity, that is, the rhythm of the heartbeat, is checked. |
| Echocardiogram (Echo) | This is like a heart scan. It can clearly see how the heart's chambers, walls, and valves are working, how thick the walls are, and whether there are any obstructions to the blood flow. |
| Cardiac MRI | This test is done to obtain very clear, detailed images of the heart muscle. |
| Cardiac Catheterization | A test in which a small tube is passed through a vein in the arm or leg into the heart to check for blockages in the heart's blood vessels and the pressure inside the heart. |
How the surgery is performed step by step
Since this is an open-heart surgery, you will be given general anesthesia. This means that you will not feel any pain, you will be in a deep sleep. You will not feel anything from the beginning of the surgery until the end.
After you are asleep, the surgical team will follow these steps:
1. Accessing the heart: The surgeon makes a vertical incision down the middle of your chest, carefully separating the breastbone (sternum) in two to access the heart.
2. Connecting to the Heart-Lung Machine: Next, you will be connected to a heart-lung machine . This is an amazing machine. During the surgery, the work of your heart and lungs, which is pumping blood around the body and adding oxygen to the blood, is temporarily done by this machine. This allows the surgeon to stop the heart and perform the surgery in a calm, bloodless environment.
3. Removing the thickened part: Now comes the main part. The surgeon will very carefully cut away the extra muscle part of the thickened wall (septum) of the heart. This is done only to the extent necessary to remove the obstruction to blood flow.
4. Weaning: After the surgery is over, you will be disconnected from the heart-lung machine, and your heart will start working on its own again.
5. Closing the incision:Finally, the sternum is reattached and the chest incision is closed with dissolvable stitches.
The entire surgery usually takes about three or four hours .
What happens after the surgery?
After surgery, you will be admitted directly to the Intensive Care Unit (ICU) , where your heart rate and blood pressure will be closely monitored.
- For the first 24-48 hours, you may have a urine catheter and a chest drainage tube in place to drain excess fluid. Don't worry about these, they are temporary.
- After about 48 hours, you will begin to walk slowly with the help of a physical therapist.
- Most people stay in the hospital for less than five days, after which they can go home.
What are the benefits and risks of this surgery?
As with any surgery, there are benefits and minor risks. However, Septal Myectomy is a very successful, low-risk surgery.
| Main advantages of the surgery | |
|---|---|
| Disappearance of symptoms | After surgery, symptoms such as shortness of breath (dyspnea), chest pain (angina), and fainting (syncope) will almost completely disappear. You will be able to lead an active life again. |
| Having high success | This surgery has a very high success rate. According to one study, 94% of people who underwent the surgery experienced relief from their symptoms. |
| Long-term results | The results of this surgery are long-lasting. After the surgery, patients' life expectancy has been found to be similar to that of a normal healthy person. |
| Possible complications (Risks) - (These are not common) | |
|---|---|
| Fluid buildup around the heart or lungs | Sometimes fluid can build up around the heart or lungs. This can usually be treated with medication. |
| Atrial Fibrillation | An irregular heartbeat. This can also often be controlled with medication. |
| Heart Block | Disruptions in the heart's electrical signals. This can cause irregular heartbeats (arrhythmias). In some rare cases, a pacemaker may need to be implanted as a treatment. |
Remember, the risk of these complications is increased in people with other heart conditions, smokers, and those over the age of 65. In a healthy person, this risk is very low.
How will you feel during recovery?
You will start to feel a lot better within a few days or weeks after the surgery. You will notice the difference as things like shortness of breath go away.
- In the beginning, you may feel a slight pain or tightness in your chest, but it should not be unbearable.
- It's normal to feel a little tired and low on energy after surgery, but your energy will return to normal within a few weeks.
When should you see a doctor?
It is very important to monitor your recovery after you go home. If you experience any of the following symptoms, you should contact your doctor immediately .
| Symptoms to watch out for | |
|---|---|
| Cut-related problems | If there is unusual redness, swelling, or warmth around the surgical site (incision). |
| Fever | If the body temperature rises above 100.4 Fahrenheit (38 Celsius) . |
| Weight gain | If you suddenly gain more than 2.5 kg (5 pounds) of weight in a week (this may be a sign of fluid retention). |
| Difficulty breathing | If you suddenly have difficulty breathing or chest pain. |
Septal Myectomy is a major surgery. But it is a very successful and life-changing treatment for Hypertrophic Cardiomyopathy. After this surgery, you will be able to live a normal life without fear, without fatigue, again. If you have these symptoms, do not hesitate to talk to your doctor, get the necessary tests done, and ask more about this.
Take-Home Message
- Septal Myectomy is an open-heart surgery performed for the condition Hypertrophic Cardiomyopathy , in which the heart wall is abnormally thick.
- This surgery involves cutting out an extra section of the thickened heart wall, removing the obstruction to blood flow in the heart.
- This surgery is usually recommended for those whose symptoms cannot be controlled with medication.
- This is a highly successful, low-risk procedure. Most people experience complete relief from symptoms after the procedure.
- Recovery after surgery takes several weeks, and it is very important to follow medical instructions during that time.
- If you develop any unusual symptoms, such as swelling of the incision, fever, or sudden weight gain, notify your doctor immediately.
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