FAQ, part 2

What kind of surgery do they do for HCM?

It's called a myectomy. In short, it's open-heart surgery where the cardiac surgeon accesses the inside of the heart from the top (through the aortic valve) and shaves off some of the overgrown tissue.

Sounds extreme. What did you mention before - something about an "alcohol ablation"?

Yes, a septal alcohol ablation. This is done in the catheterization lab. The interventional cardiologist locates the precise area of the individual coronary artery that supplies the overgrown septum and injects a small amount of alcohol. This kills the area of the overgrown septum (it induces a small, controlled heart attack), which over time should shrink the area and reduce or eliminate the obstruction.

Advantages: Quicker procedure and much shorter recovery time.
Disadvantages: Greater likelihood of needing a pacemaker, questions about long-term efficacy.

Surgery is greatly preferred for young, active patients. In one of my favorite books, Walk on Water, a cardiac surgeon beautifully summarized the dilemma of interventional cardiology versus cardiac surgery: "Interventional cardiology is beautiful on the outside and ugly on the inside. Surgery is ugly on the outside and beautiful on the inside." The bottom line is that the surgery is much more precise and, I believe, likely to fix the problem the best.

Where/when are you having the surgery?

At the Cleveland Clinic, by Dr. Nicholas Smedira, Jan. 7, 2010. There's no better place on the planet for heart care, and for the myectomy procedure specifically. Read up on the Clinic's outcomes - specifically, page 46 of the brochure.

It would help if you lost some weight.

Strictly speaking, that isn't a question.

Sorry. Would you feel better if you lost some weight?

Wouldn't we all?

The HCM isn't caused by my weight, and it won't be reversed if I did lose weight (though my exercise tolerance could be improved). I'm doing what I can to eat less and move more (the only true way to weight loss). It's difficult right now because I can't sustain any elevation of heart rate, and anaerobic exercise (weights/strength training) truly makes me dizzy and light-headed. Though I don't intend myectomy to be a weight-loss surgery per se, I do expect to return to my highly active lifestyle once recovered - including regular gym workouts and walking a golf course. Neither of these are things I can do right now. Give me back my activity and my diet constructed to support it, and I expect that my weight will drop.

How long is the recovery?

6 weeks before I can drive; I'm anticipating at least 8 weeks off work, maybe a little more, depending on my stamina. I expect residual pain and issues for 6 months to a year after the surgery. I've read a lot of myectomy stories, and the one thing I've consistently taken from them is that everyone's experience is different and everyone heals at their own pace, with their own issues.

That covers the range of questions I get most frequently. Feel free to post a question using the comments tool and I'll be happy to answer here.

Take care,

Michael