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Medical, non-surgical and surgical interventions for HCM treatment

  • July 25, 2022
  • Number of views: 839
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In addition to mavacamten, the Hypertrophic Cardiomyopathy Center offers people with HCM a range of medical, interventional and surgical options. 

Surgery to treat obstructive HCM works by thinning the thickened heart muscle. This option, first available in the 1960s, has been the standard of care for more than 20 years. Washington University cardiothoracic surgeons Ralph Damiano Jr., MD, and Kunal Kotkar, MD, specialize in this surgical procedure, called septal myectomy. A newer, less invasive treatment, called mini-sternotomy, is another option and may offer some people a speedier recovery. 

“The incision used in a mini-sternotomy is less than half the length of that required for traditional septal myectomy,” notes Kotkar. “But both procedures can offer good outcomes.”

Kotkar also specializes in a more complex procedure called apical myectomy, available at the Washington University and Barnes-Jewish Heart & Vascular Center and at only a few other centers in the U.S. “Some patients with HCM have an obstruction inside one of the lower chambers of the heart,” Kotkar says, “so we work inside the ventricle to remove the blockage and create a larger cavity for blood flow.” 

A less invasive procedure called alcohol septal ablation is an option for people who may not be able undergo surgery. In alcohol septal ablation, Washington University interventional cardiologist Richard Bach, MD, FACC says, “we use a balloon catheter to block the septal artery that moves blood into the area of thickened muscle.” Once the balloon is in place, alcohol is injected into the area, which destroys the thickened tissue. “As a result, some of the obstruction is relieved almost immediately, and, as the treated area heals, the septum is thinned without requiring open-heart surgery,” Bach adds.

Some people with HCM develop atrial fibrillation, an abnormal heart rhythm that may lead to heart failure if untreated. In 1987, James Cox, MD, former chief of cardiothoracic surgery at Washington University, and colleagues developed what’s now known as the Cox-Maze procedure. During Cox-Maze surgery, specialists create a series of tiny incisions in the heart that block abnormal electrical signals. 

Since then, Damiano has introduced less invasive advances to this procedure that have further improved outcomes for patients. He also performs a combined treatment that includes septal myectomy and a modified Cox-Maze procedure to treat HCM and atrial fibrillation simultaneously.

Not all people with HCM develop obstruction. For people with non-obstructive HCM, treatment options include medication and, for those who aren’t helped by medication, heart transplantation. Physician-researchers at the Hypertrophic Cardiomyopathy Center are involved in clinical trials evaluating new medications to treat non-obstructive HCM, and they collaborate closely with the Washington University and Barnes-Jewish Transplant Center for people needing transplantation.

Referring Patients to the Hypertrophic Cardiomyopathy Center

The Washington University Hypertrophic Cardiomyopathy Center is accredited by the National Hypertrophic Cardiomyopathy Association and has a dedicated multidisciplinary team of HCM specialists, including cardiologists, genetic cardiologists, electrophysiologists and cardiothoracic surgeons, as well as a team of experienced imaging specialists and nurses. Services include:

  • Genetic testing
  • Advanced cardiac imaging
  • Electrophysiology evaluations
  • Medical, non-surgical and surgical interventions
  • Athlete screenings
  • Counseling

To refer a patient to the center, call: 314-362-1963.

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