A 35-year-old woman presents with gradually progressive exertional dyspnoea and syncope. Echocardiography shows asymmetric left ventricular hypertrophy (septal thickness 22 mm), systolic anterior motion (SAM) of the mitral valve, and a dynamic LVOT gradient of 62 mmHg at rest. She is on verapamil. What is the CURRENT preferred invasive treatment for medically refractory obstructive hypertrophic cardiomyopathy?

• A Surgical septal myectomy (Morrow procedure) ✓
• B Alcohol septal ablation
• C Implantable cardioverter defibrillator (ICD)
• D Cardiac transplantation

Explanation

For medically refractory obstructive HCM (LVOT gradient ≥50 mmHg at rest/provocation), AHA/ACC 2020 HCM guidelines recommend surgical septal myectomy (Morrow procedure) as the gold standard (Class I) for eligible patients at experienced centres — it achieves the most durable and complete LVOT obstruction relief with mortality <1% at expert centres. Alcohol septal ablation is an alternative (Class IIa) for patients who are poor surgical candidates. ICD is for SCD prevention but does not relieve obstruction.

Reference: Harrison's Principles of Internal Medicine, 21st ed.

High-yield for: NEET PGINI-CETNExTFMGEUSMLEPLABMRCP

Written and medically reviewed by the StethoPrep medical team.