Septal myectomy

[Christy__0__0]

  I am a 30 year old female with diabetis mellitus and diabetic retinopathy.  I was also diagnosed with IHSS about 5 years ago.   My first doctor treated me with medication.  However, my new doctor is looking at septal myectomy due to my low blood pressure and cases of sudden death in the family.   I am concerned though about being a diabetic having this type of operation.  I know diabetics take longer to heal.. and I'm worried about the complications that could arise after surgery that may increase due to the fiact that I am a diabetic.  

[Cleveland Clinic, MD]

Dear Christy,
Thank you for your question.  IHSS (Idiopathic Hypertrophic Subaortic Stenosis), now commonly referred to as HOCM (Hypertrophic Obstructive CardioMyopathy), is a congenital (meaning that it runs in families) condition that results in thickening of the heart muscle (hypertrophy), a increased pressure gradient (obstruction) across the outflow tract and a cardiomyopathy (abnormal function of the heart muscle).  
Symptoms of HOCM include shortness of breath, lightheadedness, fainting and chest pain. Some patients experience cardiac rhythm disturbances which in some cases may lead to sudden death.   Due to this possibility patients with this condition are advised to avoid competitive sports (normal activity levels are OK). The obstruction to blood flow from the left ventricle increases the work the ventricle must do, and a heart murmur may be heard.
The treatment of HOCM may be several fold.  Medications, such as beta blockers and calcium channel blockers, are often given to attempt to decrease the workload of the heart.  Surgery may be recommended in patients with very high pressure gradients in the heart.  In a septal myectomy he surgeon goes into the heart and removes part of the muscle that is obstructing the blood outflow.   A alternative procedure that is being developed here and at several other centers that avoids the need for surgery.  A catheter (tiny tube) is threaded through the leg to the heart and the blood vessels that supply the thickened heart muscle are identified and then closed off with a solution of alcohol.  This results in a thinning of that particular area of the heart.  Not all patients are eligible for this procedure and there are benefits and risks to both procedures.
The issue of sudden death is not addressed by surgical means but rather by the implantation of a device called a defibrillator.  This device is similar to a pacemaker and keeps track of the heart rhythm.  If it detects a life-threatening rhythm it delivers a shock of electricity to the heart to get it back into regular rhythm.  Once again not everyone is eligible for this device and there are benefits and risks involved.
There is a cardiologist here who specializes in this condition and is an authority in the field.  His name is Dr. Harry Lever.   If you are interested in making an appointment with him you may do so by calling the number below.
Additional web sites with information about HOCM are listed below.
http://www.americanheart.org/Heart_and_Stroke_A_Z_Guide/cmyopa.html
Information provided here is for general educational purposes only. Only your doctor can provide specific diagnoses and treatments. If you would like to be seen at the Cleveland Clinic, please Call 1 - 800 - CCF - CARE for an appointment at Desk F15 with a cardiologist.