Hypertrophic cardiomyopathy is a common genetic cardiovascular disease affecting the general population with an estimated prevalence of 1 in 500 with autosomal dominant pattern of inheritance and is an important cause of intractable heart failure. Up to 70 % of patients present with left ventricular outflow tract obstruction due to asymmetric hypertrophy of the interventricular septum and systolic anterior motion of anterior mitral leaflet. These patients are initially managed with medical treatment. Persistent symptoms (dyspnea and chest pain NYHA class 3 or 4 and syncope) in spite of optimal medical therapy and presence of gradients above 50 mm of Hg at rest or by provocation are usually referred for invasive strategy. Extended surgical myectomy and alcohol septal ablation are current strategies employed for relief of left ventricular outflow tract gradients. There is a higher incidence of residual gradients, more incidences of conduction blocks requiring pacemaker implantation and more risk of life-threatening arrhythmias with alcohol ablation compared to surgery and hence is currently recommended as a treatment option only in elderly patients with poor risk profile for surgery. Early and long-term results after surgery are excellent, making it as the gold standard for management of hypertrophic cardiomyopathy. © 2015, Indian Association of Cardiovascular-Thoracic Surgeons.
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Dr. Praveen Varma, Raman, S. P., Neema, P. K., and Shekar, P. S., “Hypertrophic cardiomyopathy”, Indian Journal of Thoracic and Cardiovascular Surgery, vol. 31, pp. 153-161, 2015.