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. 2022 Jun 15;9:853582. doi: 10.3389/fcvm.2022.853582

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Copyright © 2022 Raffa, Franca, Lachina, Palmeri, Kowalewski, Lebowitz, Ricasoli, Greco, Sciacca, Turrisi, Morsolini, Stringi, Mattiucci and Pilato.

This is an open-access article distributed under the terms of the Creative Commons Attribution License (CC BY). The use, distribution or reproduction in other forums is permitted, provided the original author(s) and the copyright owner(s) are credited and that the original publication in this journal is cited, in accordance with accepted academic practice. No use, distribution or reproduction is permitted which does not comply with these terms.

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Extended septal myectomy. Surgical view of the left ventricle outflow tract before the procedure is depicted in panel (A). Transaortic myectomy was performed in all patients starting at nadir of the right coronary sinus, and extended apically to achieve exposure of the papillary muscles bases. Muscular resection was extended toward the lateral ventricular wall up to the left trigone (B). Subvalvular mitral apparatus remodeling included (1) resection of fibrotic, thickened, and agglutinated secondary chordae tendineae from the tip of the papillary muscles to the ventricular surface of the anterior mitral leaflet (C); (2) resection of all anomalous muscular trabecula and splitting (**) of hypertrophied and thickened papillary muscles (D). LAL, left aortic leaflet; NCL, non-coronary leaflet. *Interventricular septum bulging.