Treatment of obstructive hypertrophic cardiomyopathy: the role of modern imaging and the place of surgery in the era of myosin inhibitors

Authors

DOI:

https://doi.org/10.14739/2310-1210.2026.4.358600

Keywords:

hypertrophic cardiomyopathy, septal myectomy, multimodality imaging, cardiac MRI, cardiac CT, myosin inhibitors, mavacamten

Abstract

Aim. To evaluate modern approaches to preoperative planning of septal myectomy in patients with obstructive hypertrophic cardiomyopathy (HCM), to define the role of multimodality imaging (echocardiography, magnetic resonance imaging (MRI), computed tomography (CT)) and the place of surgical treatment in the era of rapid development and clinical implementation of selective myosin inhibitors.

Materials and methods. An analytical review of current clinical guidelines, results of major clinical trials on myosin inhibitors, and fundamental publications on the principles of radiological planning and surgical techniques in obstructive HCM was performed. A literature search was conducted in PubMed, Scopus, and Google Scholar databases with the following keywords: hypertrophic cardiomyopathy, septal myectomy, preoperative planning, cardiac CT, cardiac MRI, myosin inhibitors.

Results. Modern multimodality imaging represents an essential stage of preoperative assessment, providing the surgeon with the ability to optimally plan the extent of resection, minimize cardiopulmonary bypass time, and significantly reduce postoperative complications. Although myosin inhibitors demonstrate a marked reduction in left ventricular outflow tract gradients and improvement in clinical status – the complex morphological nature of obstruction, involving papillary muscles, subvalvular structures of the mitral valve, and systolic anterior motion of the anterior leaflet of the mitral valve – often limits the possibility of complete correction by medical therapy alone.

Conclusions. Septal myectomy, when performed in highly specialized expert centers, remains the gold standard for patients with symptomatic obstructive HCM refractory to optimal medical therapy. The success and safety of this intervention are directly correlated with the precision and detail of preoperative planning, based on the modern cardiac imaging arsenal.

Author Biographies

M. O. Tregubova, Bogomolets National Medical University

Postgraduate student, Department of Radiology and Radiation Medicine; Radiologist, Head of the Department of Radiation Diagnostics, State Institution “National Scientific Center of Cardiovascular Surgery and Hereditary Pathology named after M. M. Amosov of the National Academy of Medical Sciences of Ukraine”, Kyiv

K. V. Rudenko, State Institution “National Scientific Center of Cardiovascular Surgery and Hereditary Pathology named after M. M. Amosov of the National Academy of Medical Sciences of Ukraine”, Kyiv

MD, PhD, DSc, Professor, Cardiac Surgeon, Deputy General Director for Scientific and Coordination Work; Corresponding Member of the National Academy of Medical Sciences of Ukraine

M. M. Tkachenko, Bogomolets National Medical University

MD, PhD, DSc, Professor, Head of the Department of Radiology and Radiation Medicine

P. A. Danchenko, National Scientific Center of Cardiovascular Surgery and Hereditary Pathology named after M. M. Amosov of the National Academy of Medical Sciences of Ukraine

Cardiac Surgeon, Department of Surgical Treatment of Myocardial Pathology, Transplantation and Mechanical Support of the Heart and Lungs

A. O. Bei, National Scientific Center of Cardiovascular Surgery and Hereditary Pathology named after M. M. Amosov of the National Academy of Medical Sciences of Ukraine

Intern Surgeon, Department of Surgical Treatment of Myocardial Pathology, Transplantation and Mechanical Support of the Heart and Lungs

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2026-07-08

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1.
Tregubova MO, Rudenko KV, Tkachenko MM, Danchenko PA, Bei AO. Treatment of obstructive hypertrophic cardiomyopathy: the role of modern imaging and the place of surgery in the era of myosin inhibitors. Zaporozhye Medical Journal [Internet]. 2026Jul.8 [cited 2026Jul.13];28(4):358-64. Available from: https://zmj.zsmu.edu.ua/article/view/358600

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Vol. 28 No. 4 (2026)

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Review

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Copyright (c) 2026 M. O. Tregubova, K. V. Rudenko, M. M. Tkachenko, P. A. Danchenko, A. O. Bei

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