What is the primary treatment for symptomatic hypertrophic cardiomyopathy not responding to medical therapy?

Septal myectomy is considered the primary treatment for symptomatic hypertrophic cardiomyopathy that does not respond to medical therapy. This surgical procedure involves the resection of a portion of the thickened septum, which is the wall separating the left and right ventricles of the heart. By removing this excess muscle, the outflow tract of the left ventricle is widened, which directly alleviates the obstruction that can cause significant symptoms, such as exertional dyspnea, chest pain, and syncope.

In patients who have not had success with medications—such as beta-blockers or calcium channel blockers, which are commonly used to manage symptoms—septal myectomy offers a surgical solution that can dramatically improve quality of life and reduce the risk of severe complications related to the disease. This intervention is particularly beneficial in younger patients or those who are otherwise healthy enough to undergo major surgery.

While other interventions such as ablative therapies (like alcohol septal ablation) can also be effective, septal myectomy is often preferred for more severe cases or in patients who have a clear obstruction, as it provides a more definitive cure by directly addressing the structural abnormality.