We read with interest the article on transmitral septal myectomy for hypertrophic cardiomyopathy (HCM) published in The Annals. The authors state that this approach should be givenconsideration as the preferred method for correction of HCM.Transmitral approaches to myectomy—conventional orminimally invasive—are well known. Although innovative, the collected experience is not large enough to make a definite impression.
There are many negative aspects to the transmitral approach. Hypertrophied ventricle and poorly complaint leftatrium makes the exposure to the mitral valve and septum difficult in these patients. Compared with the transaortic approach, the site of the first septal incision is difficult to judgeand may lead to increased incidence of post-operative heartblock, resulting in increased need for permanent pacemaker implantation.
