Cor Vasa 2003, 44(2):80-84
Catheter-based management of hypertrophic obstructive cardiomyopathy
- 1 Oddělení srdeční chirurgie
- 2 Klinika zobrazovacích metod, Fakultní nemocnice Motol a 2. lékařská fakulta Univerzity Karlovy, Praha, Česká republika
Introduction:
Percutaneous transluminal septal myocardial ablation (PTSMA) is the method of choice in the treatment of symptomatic patients with hypertrophic obstructive cardiomyopathy (HOCM). The paper reports on the authors' mid-term experience with the method.
Group of patients:
PTSMA was performed in 32 patients (13 males, age 54 ± 14 years) with symptomatic HOCM resistant to drug therapy. Patients underwent clinical examination and echocardiography prior to the procedure and at 6, 12, or 24 months thereafter. The follow-up period was 13 ± 9 months (median 12 months).
Results:
Two patients died during follow-up. The other patients experienced regression in angina (2.3 ± 0.7 vs. 0.9 ± 0.7 CCS class; p < 0.0001) and dyspnoe (2.6 ± 0.7 vs. 1.4 ± 0.6 NYHA class; p < 0.0001). Echocardiographic follow-up revealed left ventricular remodeling with mild left ventricular dilation (45 ± 5 vs. 49 ± 6 mm; p < 0.01) and thinning of the basal segment of the interventricular septum (22 ± 4 vs. 14 ± 3 mm; p < 0.0001). There was also a reduction in resting and provoked intraventricular gradients (73 ± 49 vs. 26 ± 29 mm Hg; p < 0.0001, and 113 ± 55 vs. 41 ± 39 mm Hg; p < 0.0001, respectively).
Conclusion:
In markedly symptomatic HOCM patients, PTSMA improves the symptomatology, reduces intraventricular obstruction and left ventricular remodeling. Considering the favorable experience with this method reported to date, PTSMA can be recommended to most symptomatic HOCM patients in whom drug therapy has failed to provide a satisfactory improvement in the quality of life.
Keywords: Hypertrophic obstructive cardiomyopathy; Alcohol septal ablation; Percutaneous transluminal septal myocardial ablation
Published: February 1, 2003 Show citation