Hypertrophic Cardiomyopathy

To the Editor: We feel compelled to object to much of the content of the article on hypertrophic cardiomyopathy (HCM) by Dr Fananapazir,¹ published as a Grand Rounds from the National Institutes of Health.

First, the ventricular septal myotomy-myectomy operation is at present the treatment of choice for patients with severe outflow obstruction and disabling symptoms refractory to drug treatment. At experienced centers, surgery has proved (for more than 40 years) to be highly successful in relieving obstruction and symptoms on a long-term basis and has an operative mortality that is now low (≤1%-2%).² Indeed, some surgeons have reported virtually no operative mortality in more recent years.³ Therefore, the statement by Fananapazir that "these are major operations with significant mortality and morbidity" is misleading. Readers should be aware that surgery remains an important option for severely symptomatic patients with obstructive HCM.