Anesthetic management of transapical beating-heart septal myectomy in a child with obstructive hypertrophic cardiomyopathy: a case report

BACKGROUND: Transapical beating‑heart septal myectomy (TA‑BSM) is considered an effective surgical approach for obstructive hypertrophic cardiomyopathy (oHCM). However, data regarding its application in pediatric patients remain limited. To date, no cases have been reported detailing the anesthetic management for pediatric oHCM patients undergoing TA‑BSM. CASE PRESENTATION: We report the case of a 9‑year‑old girl with oHCM who underwent TA‑BSM under general anesthesia. Despite thorough preoperative preparation, she experienced significant perioperative complications, including hypotension and ventricular arrhythmias. Cardiac arrest occurred during rotation of the beating‑heart myectomy device (BMD) to adjust its angle. This critical event was successfully managed through direct epicardial compression, emergency temporary pacemaker implantation, and multidisciplinary collaboration, ultimately resulting in the patient's favorable recovery. Pathology confirmed obstructive hypertrophic cardiomyopathy. CONCLUSION: Perioperative multidisciplinary collaboration and meticulous hemodynamic management are essential for the safe performance of TA‑BSM in pediatric patients with oHCM, offering guidance for similar cases.