Do you sometimes feel that you have difficulty breathing, feel like your chest is constricting, or feel faint when you climb stairs or do something that requires a little effort? There can be many reasons for these symptoms. One of the main reasons is the thickening of the heart muscle. In medical terms, we call this 'Hypertrophic Cardiomyopathy'. So, when this condition is difficult to control with medication, there is a special surgery that doctors recommend. Today we are talking about a surgery called 'Septal Myectomy'.
Simply put, what does this thickening of the heart wall mean?
Our heart is a very amazing organ. It is like a small house with four rooms. There are two upper chambers (atria) and two lower chambers (chambers). The two main chambers below these, that is, the right and left chambers, are separated by a thick wall in the middle. This wall made of muscles is what we call the 'septum' .
In a condition called 'Hypertrophic Cardiomyopathy', the muscle in this septum thickens excessively. Imagine what would happen if the wall separating two rooms in your house suddenly swelled and pushed one room inward. That's what's happening here. This thickened wall pushes inward, especially into the left ventricle, the main chamber that pumps blood to the body.
Then, the path for blood to leave the heart becomes blocked. Because of this, the heart has to work harder than usual, under greater pressure, to pump blood to the rest of the body. This is why the symptoms we talked about earlier, such as shortness of breath and chest pain, begin to appear. This condition can be congenital in some people, or it can develop later in life.
Who needs Septal Myectomy surgery?
Not everyone with this condition needs surgery. Your doctor will first try to control the symptoms with medication. However, in some cases, surgery is the best solution.
- For those who cannot control symptoms with medication: If symptoms such as chest pain, difficulty breathing, and dizziness cannot be controlled with medication, your doctor may consider this surgery.
- For those with a very thick heart wall (septum): Although some people have fewer symptoms, this surgery is recommended if the septum is very thick and causes significant obstruction to blood flow.
- For women who are planning to get pregnant: If a woman with this condition is planning to get pregnant, even if the symptoms are not severe, this surgery is sometimes advised. Because the pressure on the heart increases during pregnancy, it is safer to remove this obstruction early.
What should you do before surgery?
Before the surgery, the doctor will perform several tests to thoroughly examine your heart condition. There is nothing to worry about. These are done to obtain all the information needed to perform the surgery as safely and successfully as possible.
| Test | Simply put, why do it? |
|---|---|
| Blood Tests | Check the general health of the body and whether there are any other problems. |
| ECG (Electrocardiogram) | Check the electrical activity of the heart and learn about the rhythm of the heartbeat. |
| Echocardiogram (Echo) | Take a video of the heart and accurately measure the thickness of the heart's chambers, valves, and walls. |
| Cardiac MRI | Take very clear, detailed images of the heart and identify the thickened muscle area. |
| Cardiac Catheterization | A small tube is passed through a blood vessel into the heart to check the pressure inside the heart and whether there are any blockages in the blood vessels. |
Additionally, if you are taking any medications, such as blood thinners, your doctor will tell you to stop taking them a few days before surgery. If you are a smoker, quitting before surgery will greatly help your recovery.
How is the surgery done?
This is open-heart surgery. But with today's technology, these are performed very successfully and safely.
1. Anesthesia: First, you will be fully anesthetized. This means that you will not feel any pain during the surgery, and you will be in a deep sleep.
2. Surgery: The surgeon makes an incision in the middle of the chest, through the breastbone (sternum) on either side, to reach the heart.
3. Heart-Lung Machine: Next, you will be connected to a 'heart-lung machine'. This machine will do the work of your heart and lungs during the surgery.
4. Muscle removal: Next, the surgeon carefully cuts and removes the muscle part of the septum that has thickened unnecessarily. This reopens the blocked blood flow.
5. The end: Then you are disconnected from the heart-lung machine, your sternum is repositioned, and the chest incision is closed with dissolvable stitches.
This entire surgery usually takes about three to four hours .
What happens after the surgery?
After surgery, you will be admitted directly to the Intensive Care Unit (ICU). There, doctors and nurses will closely monitor your condition. You may have a urinary catheter or chest drain in place for a day or two, but don't worry about them.
In about two days, with the help of a physical therapist, you should be able to get out of bed and start walking around a little. Most people stay in the hospital for less than five days . It is normal to feel tired for a while after you go home. You will regain your normal strength within a few weeks.
What are the benefits and risks of this surgery?
Like any surgery, this one has benefits and very minor risks.
| Main advantages | Potential Risks |
|---|---|
| Symptoms such as chest pain (Angina) and shortness of breath (Dyspnea) almost completely disappear. | Fluid accumulation around the heart or lungs. |
| Being able to work without tiring the heart. | Atrial fibrillation (heart rhythm disorder). |
| The ability to live like a normal, healthy person throughout life. | Disruption of the heart's electrical signals (heart block). |
These risks do not apply to everyone. In particular, the risk may be slightly increased in people with other heart conditions, smokers, and those over the age of 65. But overall, Septal Myectomy is a surgery with a very high success rate (over 94%).
When should I see the doctor after surgery?
After you go home, it is very important to call your doctor immediately if you develop any signs of complications.
- Wound-related problems: If the area around the surgical wound is excessively red, swollen, or feels warm.
- Fever: If you have a fever of more than 38 Celsius (100.4 Fahrenheit) on a thermometer.
- Weight gain: If your weight suddenly increases by more than 2.5 kg (5 lbs) within a week (this may be a sign of fluid retention).
If you experience anything like this, don't panic, but inform your doctor immediately.
Take-Home Message
- 'Septal Myectomy' is an open heart surgery performed for 'Hypertrophic Cardiomyopathy', a disease in which the heart muscle thickens.
- This surgery is usually performed on people whose symptoms cannot be controlled with medication.
- The surgery involves removing the thickened muscle tissue that is obstructing blood flow in the heart.
- This is a highly successful surgery, and there is great relief from symptoms after the surgery.
- Although this is a major surgery, the results are very good. The most important thing is to follow your doctor's instructions carefully before and after the surgery.
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