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Patients with hypertrophic obstructive cardiomyopathy due to diffuse hypertrophy extending to or below the papillary muscles are poor candidates for alcohol septal ablation and suboptimal candidates for transaortic septal myectomy. In addition, the outflow obstruction is often aggravated by an abnormal mitral valve and subvalvular apparatus.

journal of thoracic and cardiovascular surgery

Myectomy and mitral repair through the left atrium in hypertrophic obstructive cardiomyopathy: The preferred approach for contemporary surgical candidates?