Extended septal myectomy using a combined trans-aortic and apical approach for long basal and mid-cavity hypertrophic cardiomyopathy.

Surgical septal myectomy is the treatment of choice for patients of hypertrophic cardiomyopathy who are symptomatic despite maximal medical therapy. Residual obstruction results in the persistence of symptoms and poorer outcomes. The length (depth) of the septum excised as far towards the apex is important. A combined approach of trans-aortic and trans-apical is needed to achieve this in specific cases with associated mid-cavity obstruction. We present a case of a complex long-segment septal hypertrophy which underwent a successful septal reduction using a combined trans-aortic and trans-apical approach. Supplementary Information: The online version contains supplementary material available at 10.1007/s12055-022-01377-4. © Indian Association of Cardiovascular-Thoracic Surgeons 2022.