Adapting Interventional Echocardiography to New Techniques: Echocardiographic Guidance for Transcatheter Myotomy Using Septal Scoring Along the Midline Endocardium.

Septal scoring along the midline endocardium (SESAME) is a recently developed electrosurgical, percutaneous myotomy technique. It was designed to prevent iatrogenic left ventricular outflow tract obstruction following transcatheter mitral valve replacement in patients with prohibitive surgical risk. SESAME can also be used to reduce left ventricular outflow tract obstruction in cases of obstructive hypertrophic cardiomyopathy. On the basis of >200 SESAME procedures at three experienced centers, the authors present a best-practices, step-by-step, echocardiography-guided approach, emphasizing key anatomic and procedural features. Given the complexity of the electrosurgical approach, protocol-driven imaging is essential to ensure procedural safety and optimize outcomes.