HYPERTROPHIC CARDIOMYOPATHY: SEPTAL REDUCTION STRATEGIES AND POSTOPERATIVE REHABILITATION
Keywords:
hypertrophic cardiomyopathy, phenocopies, sudden cardiac death, risk stratification, septal myectomy, ethanol septal ablation, prevention, dispensary/long-term follow-up, rehabilitationAbstract
The article focuses on surgical and interventional strategies for managing obstructive hypertrophic cardiomyopathy, emphasizing interventricular septal reduction and subsequent rehabilitation. The approaches presented are based on an analysis of the Russian Society of Cardiology (RSC, 2025) clinical guidelines for the management of hypertrophic cardiomyopathy, including the sections on septal reduction therapy and rehabilitation. It considers clinical thresholds for escalation to invasive management, including New York Heart Association (NYHA) class III–IV symptoms despite optimal medical therapy and hemodynamic criteria in the form of a significant left-ventricular outflow tract gradient. A comparative analysis is presented for septal myectomy and ethanol septal ablation with respect to selection criteria, mechanisms of obstruction relief, expected effects on symptoms and exercise tolerance, durability of outcomes, complication profiles, and the need for reintervention. A stepwise algorithm for choosing a reduction strategy is proposed, accounting for age, septal and sub valvular anatomy, the need for concomitant mitral valve repair, baseline conduction abnormalities, and patient preferences within a heart-team decision framework. Criteria for a safe return to daily activities and work are articulated, along with quality-of-care benchmarks and markers indicating the need to escalate surveillance. The article is addressed to a multidisciplinary team and aims to standardize surgical tactics and rehabilitation pathways.
References
Basavarajaiah S, Wilson M, Whyte G, et al. Prevalence of Hypertrophic Cardiomyopathy in Highly Trained Athletes. Relevance to Pre-Participation Screening. J Am Coll Cardiol. 2008;51(10):1033-9. doi:10.1016/j.jacc.2007.10.055. 363. Malhotra A, Sharma S. Hypertrophic cardiomyopathy in athletes. Eur Cardiol Rev. 2017;12(2):80-2. doi:10.15420/ecr.2017:12:1.
Bogle C, Colan SD, Miyamoto SD, et al. Treatment Strategies for Cardiomyopathy in Children: A Scientific Statement From the American Heart Association. Circulation. 2023;148(2): Epub ahead of print. doi:10.1161/CIR.0000000000001151.
Boll G, Rowin EJ, Maron BJ, et al. Efficacy of Combined Cox-Maze IV and Ventricular Septal Myectomy for Treatment of Atrial Fibrillation in Patients With Obstructive Hypertrophic Cardiomyopathy. Am J Cardiol. 2020;125(1):120-6. doi:10.1016/J.AMJCARD.2019.09.029.
Bokeria l.A., Shlyakhto E.V., et al. 2025 Clinical practice guidelines for Hypertrophic cardiomyopathy. Russian Journal of Cardiology. 2025;30(5):6387. (In Russ.) https://doi.org/10.15829/1560-4071-2025-6387. EDN: BUUCJT
Charron P, Forissier JF, Amara ME, et al. Accuracy of European diagnostic criteria for familial hypertrophic cardiomyopathy in a genotyped population. Int J Cardiol. 2003 90(1):33-8. doi:10.1016/S0167-5273(02)00534-X.
Colan SD, Lipshultz SE, Lowe AM, et al. Epidemiology and cause-specific outcome of hypertrophic cardiomyopathy in children: findings from the Pediatric Cardiomyopathy Registry. Circulation. 2007;115(6):773-81. doi:10.1161/ CIRCULATIONAHA.106.621185.
Drozdov DV, Makarov LM, Barkan VS, et al. Resting 12 lead electrocardiography for adults and children. 2023 Guidelines. Russian Journal of Cardiology. 2023;28(10):5631. (In Russ.) Дроздов Д.В., Макаров Л.М., Баркан В. С. и др. Регистрация электрокардиограммы покоя в 12 общепринятых отведениях взрослым и детям 2023. Методические рекомендации. Российский кардиологический журнал. 2023;28(10):5631. doi:10.15829/1560-4071-2023-5631. EDN: JAVUJL.
Elliot P, Zamorano JL, Anastasakis A, et al. 2014 ESC guidelines on diagnosis and management of hypertrophic cardiomyopathy: The task force for the diagnosis and management of hypertrophic cardiomyopathy of the European Society of Cardiology (ESC). Eur Heart J. 2014;35(39):2733-79. doi:10.1093/eurheartj/ehu284.
Finocchiaro G, Sheikh N, Biagini E, et al. The electrocardiogram in the diagnosis and management of patients with hypertrophic cardiomyopathy. Hear Rhythm. 2020;17(1):142-51. doi:10.1016/J.HRTHM.2019.07.019
Gabrusenko SA, Seleznev DM, Naumov VG. Genetic aspects of hypertrophic cardiomyopathy (literature review). A practicing doctor. 2000;18(2):2-5. (In Russ.) Габрусенко С.А., Селезнёв Д.М., Наумов В.Г. Генетические аспекты гипертрофической кардиомиопатии (обзор литературы). Практикующий врач. 2000;18(2):2-5.
Gurschenkov A, Andreeva S, Zaitsev V, et al. Septal Myectomy in Patients with Hypertrophic Cardiomyopathy and Nonclassical Anderson-Fabry Disease. J Cardiovasc Dev Dis. 2024;11(9):293. doi:10.3390/JCDD11090293.
Jalanko M, Heliö T, Mustonen P, et al. Novel electrocardiographic features in carriers of hypertrophic cardiomyopathy causing sarcomeric mutations. J Electrocardiol. 2018;51(6):983-9. doi:10.1016/J.JELECTROCARD.2018.07.009.
Lakdawala NK, Thune JJ, Maron BJ, et al. Electrocardiographic features of sarcomere mutation carriers with and without clinically overt hypertrophic cardiomyopathy. Am J Cardiol. 2011;108(11):1606-13. doi:10.1016/J.AMJCARD.2011.07.019.
Liebregts M, Faber L, Jensen MK, et al. Validation of the HCM Risk-SCD model in patients with hypertrophic cardiomyopathy following alcohol septal ablation. Europace. 2018;20(FI2):198-203. doi:10.1093/europace/eux251.
Lipshultz SE, Law YM, Asante-Korang A, et al. Cardiomyopathy in Children: Classification and Diagnosis: A Scientific Statement From the American Heart Association. Circulation. 2019;140(1): E9-68. doi:10.1161/CIR.0000000000000682.
Ommen SR, Ho CY, Asif IM, et al. Writing Committee Members. 2024 AHA/ACC/AMSSM/ HRS/PACES/SCMR Guideline for the Management of Hypertrophic Cardiomyopathy: A Report of the American Heart Association/American College of Cardiology Joint Committee on Clinical Practice Guidelines. J Am Coll Cardiol. 2024;83(23):2324-405. doi:10.1016/j.jacc.2024.02.014.
Ommen SR, Mital S, Burke MA, et al. 2020 AHA/ACC Guideline for the Diagnosis and Treatment of Patients With Hypertrophic Cardiomyopathy: A Report of the American College of Cardiology/American Heart Association Joint Committee on Clinical Practice Guidelines. J Am Coll Cardiol. 2020;76(25): e159-240. doi:10.1016/j.jacc. 2020.08.045.
Patten M, Pecha S, Aydin A. Atrial Fibrillation in Hypertrophic Cardiomyopathy: Diagnosis and Considerations for Management. J Atr Fibrillation. 2018;10(5):1556.
Pelliccia A, Corrado D, Bjãrnstad HH, et al. Recommendations for participation in competitive sport and leisure-time physical activity in individuals with cardiomyopathies, myocarditis and pericarditis. Eur J Prev Cardiol. 2006;13(6):876-85. doi:10.1097/01. hjr.0000238393.96975.32.
Ryzhkova OP, Kardymon OL, Prokhorchuk EB, et al. Guidelines for the interpretation of human DNA sequence data obtained by Mass parallel Sequencing (MPS) (2018 edition, version 2). Medical genetics. 2019;18(2):3-23. (In Russ.) Рыжкова О.П., Кардымон О.Л., Прохорчук Е.Б. и др. Руководство по интерпретации данных последовательности ДНК человека, полученных методами массового параллельного секвенирования (MPS) (редакция 2018, версия 2). Медицинская генетика. 2019;18(2):3-23.
Seleznev DM, Gabrusenko SA, Parfenova EV, et al. The role of mutations in the cardiac beta-myosin heavy chain gene in the Russian population of patients with hypertrophic cardiomyopathy. Kardiologiia. 2005;45(4):15-20. (In Russ.) Селезнев Д.М., Габрусенко С.А., Парфенова Е.В. и др. Роль мутаций в гене тяжелой цепи сердечного бета-миозина в российской популяции больных с гипертрофической кардиомиопатией. Кардиология. 2005;45(4):15-20.
Spoladore R, Maron MS, D’Amato R, et al. Pharmacological Treatment Options for Hypertrophic Cardiomyopathy: High Time for Evidence. Eur Hear J. 2012;33(14):1724-33.
Timmer SAJ, Knaapen P. Coronary Microvascular Function, Myocardial Metabolism, and Energetics in Hypertrophic Cardiomyopathy: Insights From Positron Emission Tomography. Eur Hear J Cardiovasc Imaging. 2013;14(2):95-101.
Tsuda T, Hayashi K, Konno T, et al. J Waves for Predicting Cardiac Events in Hypertrophic Cardiomyopathy. JACC Clin Electrophysiol. 2017;3(10):1136-42. doi:10.1016/J. JACEP.2017.03.010.
Turalchuk MV, Novik GA, Gudkova AYa. Features of the course of cardiomyopathies with a restrictive phenotype caused by mutations of the cardiac troponin I and desmin genes, and algorithms for their diagnosis. Pediatric pharmacology. 2011;8(4):112-6. (In Russ.) Туральчук М.В., Новик Г.А., Гудкова А.Я. Особенности течения кардиомиопатий с рестриктивным фенотипом, обусловленных мутациями генов сердечного тропонина I и десмина, и алгоритмы их диагностики. Педиатрическая фармакология. 2011;8(4):112-6.
Veselka J, Liebregts M, Cooper R, et al. Prediction of Sudden Cardiac Arrest After Alcohol Septal Ablation for Hypertrophic Obstructive Cardiomyopathy: ASA-SCARRE Risk Score. Am J Cardiol. 2022;184:120-6. doi:10.1016/J.AMJCARD.2022.08.028.
Vriesendorp PA, Schinkel AFL, Liebregts M, et al. Validation of the 2014 European Society of Cardiology Guidelines Risk Prediction Model for the Primary Prevention of Sudden Cardiac Death in Hypertrophic Cardiomyopathy. Circ Arrhythmia Electrophysiol. 2015;8(4):829-35. doi:10.1161/CIRCEP.114.002553.
Zhang YD, Li M, Qi L, et al. Hypertrophic cardiomyopathy: Cardiac structural and microvascular abnormalities as evaluated with multi-parametric MRI. Eur J Radiol. 2015;84(8):1480-6. doi:10.1016/j.ejrad.2015.04.028.
Zipes DP, Camm AJ, Borggrefe M, et al. ACC/AHA/ESC 2006 guidelines for management of patients with ventricular arrhythmias and the prevention of sudden cardiac death. Circulation. 2006;114(10): e385-484. doi:10.1161/CIRCULATIONAHA.106.178233.
