Transapical beating-heart septal myectomy for recurrent left ventricular outflow tract obstruction after septal reduction therapy in hypertrophic obstructive cardiomyopathy.

We present a case of a 58-year-old man for surgical myectomy due to recurrent left ventricular outflow tract (LVOT) obstruction, who had prior transaortic septal myectomy and embolization of the septal branch. On admission, transthoracic echocardiography showed a typical hypertrophic obstructive cardiomyopathy (HOCM) with asymmetric septal hypertrophy, significant LVOT obstruction, and severe mitral regurgitation (MR) due to the systolic anterior movement (SAM) of the anterior mitral valve leaflet. We performed a novel procedure of the transapical beating-heart septal myectomy (TA-BSM), following which the LVOT obstruction was resolved. And a decreased grade of SAM and a reduction in the severity of MR were observed.