Left ventricular apical aneurysm resection and correction of residual midventricular obstruction via transapical approach after alcohol septal ablation in a patient with hypertrophic cardiomyopathy

The aim of this publication is to evaluate the efficacy and safety of transapical septal myectomy for surgical correction of residual midventricular obstruction of the left ventricular outflow tract in a patient with hypertrophic cardiomyopathy in 2 years after alcohol septal ablation (ASA). Transapical septal myectomy, myocardial revascularization and left ventriculoplasty were performed under cardiopulmonary bypass and cardioplegia. Postoperatively, positive dynamics were noted with complete regression of chronic heart failure symptoms. Early postoperative period was uneventful. A follow-up echocardiography demonstrated normalization of intracardiac hemodynamics with elimination of pressure gradient and improvement of left ventricular diastolic function. If transaortic access is impossible due to distal hypertrophy or post-ASA scarring, transapical access to the apical and middle segments of the interventricular septum is essential.