Management of hypertrophic obstructive cardiomyopathy may include:

A. Propranolol and verapamil.

C. Dual-chamber sequential pacing.

D. Combined septal myectomy and mitral valve plication.

DISCUSSION: The majority of patients with hypertrophic obstructive cardiomyopathy are treated medically with betablockers such as propranolol and calcium channel blockers such as verapamil. Patients whose symptoms do not respond to medical therapy are treated surgically with a transaortic septal myectomy. Recent reports indicate that simple plication of the anterior leaflet of the mitral valve performed in addition to the septal myectomy further opens the left ventricular outflow tract by eliminating systolic anterior motion of the mitral valve. Aortic valve replacement is not an appropriate treatment for hypertrophic obstructive cardiomyopathy. Some patients who are poor surgical candidates may experience relief of symptoms and left ventricular outflow gradients with dual-chamber permanent pacing. Appropriate pre-excitation of the ventricular septum can prompt the septum to move away from the left ventricular wall during systole and open the outflow tract.