Surgical management of left ventricular outflow obstruction in hypertrophic cardiomyopathy

Hypertrophic cardiomyopathy is the single most common form of inherited heart disease. Left ventricular outflow tract obstruction (LVOTO) is a recognised feature of this condition which arises when blood leaving the outflow tract is impeded by systolic anterior motion of the mitral valve. In an important minority of patients, breathlessness, chest pain and syncope may result and persist despite the use of medications. In suitable candidates, surgery may relieve obstruction and its associated symptoms, and normalise life expectancy. Refinements in surgical techniques have marked improvements in the understanding of mechanisms underlying LVOTO. In this review, we hope to provide the reader with an understanding of how contemporary surgical practice has developed, which patients should be considered for surgery, and what results are anticipated. The role echocardiography plays in this area is highlighted throughout.