After anesthesia, transesophageal ultrasound was inserted to determine the location of left ventricular resection. The standard external circulation was established, the left ventricular drainage tube was placed, and the heart kept beating to complete the operation.
Myomectomy of left ventricle
The incision cut into the posterior descending branch at an angle of 45 between the apex and the anterior descending branch. Be careful not to operate the interventricular septum 2 cm below the mitral annulus. The other incision extends outward from the apex until the diamond-shaped myocardium is removed. McCarthy et al. reported that the left ventricle (LVDd) can be reduced by 1 ~ 2 cm by removing 300g of myocardium in one operation, which is equivalent to the weight of normal heart. In some cases, anterior incision including anterior descending branch resection is even feasible, but it is not commonly used. Batista would rather sacrifice mitral valve device for plastic surgery or valve replacement to expand the scope of left ventricular resection. Bocchi and others made a group report on preserving papillary muscles, because the number of cases was too small to compare. For mild or moderate mitral regurgitation, Fuccic's double-hole mitral valvuloplasty can be used to correct it, and Duran ring can be used for plastic surgery or valve replacement in severe cases.
Incision suture
Batista sutured the incision directly with Prolene thread without padding to reduce tissue reaction, because the scar tissue of left ventricle after operation may be the root of intractable ventricular tachycardia and there is a risk of massive bleeding.
Simultaneous operation
For right ventricular enlargement, right ventricular free wall folding and tricuspid valvuloplasty are feasible.