Reoperative myectomy via the left ventricular apex in a patient with hypertrophic obstructive cardiomyopathy.

Transaortic myectomy is the standard treatment for symptomatic patients with hypertrophic obstructive cardiomyopathy that proves to be refractive to medical therapy. We encountered a case that required a modified surgical approach to relieve a left ventricular outflow tract obstruction that could not be adequately resected through the aortic annulus because of poor exposure of the ventricular septum. Persistent high gradients after the 1st operation necessitated a 2nd operation. We used a novel approach via the left ventricular apex that enabled us to resect a large amount of obstructive tissue under direct vision and thereby to relieve the left ventricular outflow tract obstruction.