AMA Category 1 Credit for Physicians Only.
ASRT CME is not available.
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Complications after a septal myectomy are less than 1%. Complications that can occur are:
A VSD and complete heart block can occur from a too deep myectomy into the septal wall. The aortic regurgitation tends to occur because of destabilization of the aortic annulus by
beginning the myectomy to close to the right coronary cusp. A coronary artery fistula into the right ventricle has been reported. Residual stenosis can occur in an too small excision
of the septal wall or if the mitral valve has persistent SAM despite an adequate resection.
The diagnosis is a ventricular septal defect.
The VSD measured 0.88 cm in diameter with a PISA of 0.68 cm and a Va of 57.8 cm/sec.
The VTI of the VSD was 103 cm. The shunt volume was about 40 mls per cardiac cycle.
The VSD when from the left ventricle to the right ventricle and the right atrium. The RV is dilated and exhibited decreased function.
The therapeutic options are to close the VSD by percutaneous device or by patching the VSD surgically.
A VSD after a septal myectomy is rare but represents a serious complication. Along with a VSD, complete heart block may also occur, especially, if the patient had a failed alcohol ablation of the septum. Another possible complication is a coronary fistula. A case report of an LAD to RV fistula was reported. Closure with a device has been successfully reported in many patients. The technical difficultly of a device closure depend upon the location of the VSD, the size, shape, number of orifices, and orientation of the VSD, and the severity of the VSD. Large, irregular, muscular, and multiorifice VSDs are difficult to close with a device. Small, membranous, single orifice VSDs have the best success rate.
The later videos show a patch repair that later exhibited dehiscence and had to be re-repaired.
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Closure of Ventricular Septal Defect After Surgical Septal Myectomy by Hybrid Procedure in an Adult Patient
A new technique to avoid the intraoperative complications of septal myectomy in patients with obstructive hypertrophic cardiomyopathy
A successful percutaneous closure of ventricular septal defect following septal myectomy in patients with hypertrophic obstructive cardiomyopathy.
Outcome of surgical myectomy after unsuccessful alcohol septal ablation for the treatment of patients with hypertrophic obstructive cardiomyopathy.
[Coronary fistula of the right ventricular outflow tract as a complication of combined transaortic-trans-right ventricular myectomy in hypertrophic obstructive cardiomyopathy]