My septal myectomy decision, and 10 things I've learned since.

Posted by baystater101 @baystater101, Aug 16 11:28am

I had a septal myectomy, with related mitral valve repair, on July 24, 2025, 23 days ago. I’ll relate below how I decided on a septal myectomy and some of what I learned from the surgery.

What follows is a lengthy post, apparently too long for one post on this site, so I’m breaking it into 3 posts, which I hope will work.

This is post 1 of 3.

First, some background:

I am a 73-year-old man. I was told I had a heart murmur when I was in my twenties. From college days forward I have always been physically active. I rode my bicycle across the U.S. at age 22, and regularly rode long and short distances throughout my life (cutting back significantly in the past few years only because of knee pain and neuropathy in my arms). I also regularly skied, downhill and cross-country, and did a fair amount of mountain hiking, swimming, running, gym memberships, and aerobics classes. I had no HCM symptoms (and had barely heard of the condition, if at all) throughout all of this, up until I was in my 60s.

Around 7 or 8 years ago my heart murmur became more pronounced (to my PCP; I never felt it), so I was referred to a cardiologist and after tests including a transthoracic echocardiogram (TTE) and cardiac MRI I was diagnosed with HCM and received regular follow-up monitoring and tests. I still felt no symptoms, despite worsening gradients and other test results, including a septum thickness of 2.3 cm (I believe the high end of the normal range is 1.1 cm).

In June 2024 I first felt HOCM symptoms, an unexplained shortness of breath (SOB) while doing a mild hike at a tourist spot in Italy. I managed fine for the rest of that two-week vacation, as long as I took it slow and regularly rested while walking. When I returned home in July 2024 my cardiologist introduced me to my future septal myectomy surgeon, but I wasn’t ready to agree to surgery where I had been symptom-free until just a few weeks earlier.

Eventually, I reluctantly decided to try mavacamten (Camzyos). I was resistant to the prospect of taking an (expensive) medication, probably for life if it worked at easing HOCM symptoms, without directly treating the underlying cause of the SOB (in my case the over-thick septum and a defective mitral valve). I was on mavacamten from October 2024 till April 2025, but it did not relieve my SOB symptoms enough (or improve my gradients and other test results enough on repeated TTEs and another MRI) to satisfy me or my health providers that it was efficacious, so I opted for the surgery.

Up until my surgery date I had been going to the gym four or five times a week, mostly using an elliptical machine for aerobics and engaging in some light weight-lifting. I hadn’t been pushing as hard as I had been before I first felt symptoms a year ago, but until the surgery I was still getting in a good workout. In the past year, the times when I felt sudden SOB were random and unpredictable, like maybe when I would bend over to tie my shoe, or if I were walking downtown, carrying my laptop in my briefcase maybe a few extra blocks because I couldn’t find a parking space near my destination. The one time I fully fainted (lost consciousness for a couple of seconds) happened to be in July 2025, two weeks before my already-scheduled surgery. I had leaned over to take something out of the refrigerator, and when I stood up I felt woozy. I held on to the nearby countertop, and thought the moment would pass, but then woke up (unharmed) on the kitchen floor after losing consciousness for 3 to 5 seconds (my husband was in the room and heard me fall).

End of post 1. Two more posts to follow.

Interested in more discussions like this? Go to the Hypertrophic Cardiomyopathy (HCM) Support Group.

Profile picture for mbi @mbi

I also have HCM. I’m a 73 year old female and my cardiologist recommended Camzyos. After researching the drug and how some people might get heart failure while taking it, I chose to have the septal myectomy. My surgery is September 26 at Mayo in Rochester, Minnesota.
I’ve read that HCM isn’t curable, but does anyone know how long the surgery is good for. Does the thickening grow back?
I’ve been trying to walk about four- five miles a day to be a strong as I can be prior to surgery. I’m hoping this will help with my recovery.

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I was almost 76 when I had a septal myectomy at Mayo. You will be in good hands!!!! As @baystater101 stated, fitness counts. You have the walking underway! You may want to add core strength exercises such as planks (with doctor's OK), sitting to standing, and some strength and flexibility exercises. That will go a long way with the OT and PT you will be doing everyday starting the day after surgery. During the pre-op interview with my surgeon, Dr Schaff, I was asked if I wanted genetic counseling (yes, of course). Unfortunately, my errant HCM gene(s) was not found, and blood relatives are having periodic echocardiograms. If your gene can be found, relatives can be tested and action taken accordingly.

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Profile picture for walkinggirl @walkinggirl

I was almost 76 when I had a septal myectomy at Mayo. You will be in good hands!!!! As @baystater101 stated, fitness counts. You have the walking underway! You may want to add core strength exercises such as planks (with doctor's OK), sitting to standing, and some strength and flexibility exercises. That will go a long way with the OT and PT you will be doing everyday starting the day after surgery. During the pre-op interview with my surgeon, Dr Schaff, I was asked if I wanted genetic counseling (yes, of course). Unfortunately, my errant HCM gene(s) was not found, and blood relatives are having periodic echocardiograms. If your gene can be found, relatives can be tested and action taken accordingly.

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Thank you! I did the recommended genetic testing because I have three daughters. I didn’t have the gene. So I’m wondering how I got it? And if the septal myectomy will permanently take care of it.

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Profile picture for baystater101 @baystater101

mbi, good luck with your upcoming surgery. If you're like me, now that you've made the decision to undergo surgery, you want the date to hurry up and get here. This is a good time to practice cultivating patience and equanimity, traits that will serve you well during what can on occasion be a tumultuous post-op period.

Your plan to be in the best shape possible pre-surgeey is a good one; it will definitely help you in the days and weeks post-surgery. I am your age, and almost 4 weeks post-surgery, and am finding my pre-surgery overall fitness level is setving me well during this recovery period.

My understanding is that the septal myectomy is consudered to be a "one-and-done" operation. For someone your (and my) age, I think it is safe to assert that the septum does not grow back.

Having said that, in my self-education over the past year or so I came across a few references suggesting that there are cases where the septum has, in fact, grown back, but if my understanding is correct this is rare, and has happened where the patient was relatively young when their myectomy took place, and/or there were questions whether the first myectomy was procedurally up to snuff. With your surgery set for the Mayo Clinic, you have little to worry about with regard to the experience and technical expertise of your surgical team.

You're right that HCM is not curable, but, like me, you have chosen the treatment plan that directly addresses what for you (and me) is the defining feature of the disease -- the overgrown septum -- so you (and I) should have every confidence that we will remain symptom free after the recovery period.

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Thank you!!!

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Profile picture for mbi @mbi

Thank you! I did the recommended genetic testing because I have three daughters. I didn’t have the gene. So I’m wondering how I got it? And if the septal myectomy will permanently take care of it.

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I also did the genetic test and did not show any of the genetic markers for HCM that have been identified to date.

My (layman's) understanding is that (1) only about half of those who get tested show one or more of the known genetic markers for HCM; and (2) the scientific consensus is that for the other half, like you and me, we probably inherited the condition via other genetic variants that have not yet been identified.

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Profile picture for mbi @mbi

Thank you! I did the recommended genetic testing because I have three daughters. I didn’t have the gene. So I’m wondering how I got it? And if the septal myectomy will permanently take care of it.

Jump to this post

@baystater101 is absolutely correct about many unknown HCM genes - HCM is a genetic condition. Do you know of other family members with heart issues? My dad was never diagnosed with anything other than a mitral valve murmur but had the out-of-breath symptoms. I had 123 of the known (in 2022) tested and all were OK and was told that I should check back in 5 years. You may wish to read: https://www.jpost.com/health-and-wellness/article-852473 I passed this article on to Lauren, my Mayo genetic counselor, who is now researching the findings. Meanwhile, please discuss with your cardiologist about echocardiograms for your daughters. My son is to have an echo every 5 years and teenaged grandson every two. So far, all good!

REPLY
Profile picture for walkinggirl @walkinggirl

@baystater101 is absolutely correct about many unknown HCM genes - HCM is a genetic condition. Do you know of other family members with heart issues? My dad was never diagnosed with anything other than a mitral valve murmur but had the out-of-breath symptoms. I had 123 of the known (in 2022) tested and all were OK and was told that I should check back in 5 years. You may wish to read: https://www.jpost.com/health-and-wellness/article-852473 I passed this article on to Lauren, my Mayo genetic counselor, who is now researching the findings. Meanwhile, please discuss with your cardiologist about echocardiograms for your daughters. My son is to have an echo every 5 years and teenaged grandson every two. So far, all good!

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Two of my daughters had an echo last month. So far they are ok, but need to repeat in five years.
Thanks for the info.!

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Profile picture for baystater101 @baystater101

mbi, good luck with your upcoming surgery. If you're like me, now that you've made the decision to undergo surgery, you want the date to hurry up and get here. This is a good time to practice cultivating patience and equanimity, traits that will serve you well during what can on occasion be a tumultuous post-op period.

Your plan to be in the best shape possible pre-surgeey is a good one; it will definitely help you in the days and weeks post-surgery. I am your age, and almost 4 weeks post-surgery, and am finding my pre-surgery overall fitness level is setving me well during this recovery period.

My understanding is that the septal myectomy is consudered to be a "one-and-done" operation. For someone your (and my) age, I think it is safe to assert that the septum does not grow back.

Having said that, in my self-education over the past year or so I came across a few references suggesting that there are cases where the septum has, in fact, grown back, but if my understanding is correct this is rare, and has happened where the patient was relatively young when their myectomy took place, and/or there were questions whether the first myectomy was procedurally up to snuff. With your surgery set for the Mayo Clinic, you have little to worry about with regard to the experience and technical expertise of your surgical team.

You're right that HCM is not curable, but, like me, you have chosen the treatment plan that directly addresses what for you (and me) is the defining feature of the disease -- the overgrown septum -- so you (and I) should have every confidence that we will remain symptom free after the recovery period.

Jump to this post

Thanks for the info!
Now I need to find out if I have to take my C-Pap machine with me, lol

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