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. 2000 Mar;83(3):326–331. doi: 10.1136/heart.83.3.326

Percutaneous transluminal septal myocardial ablation for hypertrophic obstructive cardiomyopathy: long term follow up of the first series of 25 patients

L Faber 1, A Meissner 1, P Ziemssen 1, H Seggewiss 1
PMCID: PMC1729336  PMID: 10677415

Abstract

OBJECTIVE—To determine the long term outcome in patients treated with percutaneous transluminal septal myocardial ablation (PTSMA) for hypertrophic obstructive cardiomyopathy (HOCM).
DESIGN AND SETTING—Observational, single centre study.
PATIENTS—25 patients (13 women, 12 men, mean (SD) age 54.7 (15.0) years) with drug treatment resistant New York Heart Association (NYHA) class 2.8 (0.6) symptoms attributed to a high left ventricular outflow gradient (LVOTG) and a coronary artery anatomy suitable for intervention.
INTERVENTION—PTSMA by injection of 4.1 (2.6) ml of alcohol (96%) into 1.4 (0.6) septal perforator arteries to ablate the hypertrophied interventricular septum.
OUTCOME MEASURES—During in-hospital follow up, enzyme rise, the frequency of atrioventricular conduction lesions requiring permanent DDD pacing, and in-hospital mortality were assessed. Long term follow up (30 (4) months, range 24-36 months) included symptoms, echocardiographic measurements of left atrial and left ventricular dimensions and function, and LVOTG.
RESULTS—Mean postinterventional creatine kinase rise was 780 (436) U/l. During PTSMA 13 patents developed total heart block, permanent pacing being necessary in five of them. One 86 year old patient died from ventricular fibrillation associated with intensive treatment (β mimetic and theophylline) for coexistent severe obstructive airway disease. After three months, three patients underwent re-PTSMA because of a dissatisfactory primary result, leading to LVOTG elimination in all of them. During long term follow up, LVOTG showed sustained reduction (3 (6) mm Hg at rest and 12 (19) mm Hg with provocation) associated with stable symptomatic improvement (NYHA class 1.2 (1.0)) and without significant global left ventricular dilatation.
CONCLUSIONS—PTSMA is an effective non-surgical technique for reduction of symptoms and LVOTG in HOCM. Prospective, long term observations of larger populations are necessary in order to determine the definitive significance of the procedure.


Keywords: hypertrophic obstructive cardiomyopathy; percutaneous transluminal septal myocardial ablation; left ventricular outflow tract gradient; myocardial contrast echocardiography

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Figure 1  .

Figure 1  

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Coronary angiograms. (A) Identification of the target vessel in right anterior oblique position (arrows). (B) Injection of contrast dye to define the perfusion area and to exclude reflux into the left anterior descending coronary artery. (C) Final visualisation of the vessel stump after completed PTSMA.

Figure 2  .

Figure 2  

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Haemodynamic treatment result of PTSMA. Pressure curves of left ventricular inflow tract (LV) and aorta (AO) before (left) and after (right) intervention with complete elimination of the LVOTG and reduction of left ventricular end diastolic pressure (lower arrows).

Figure 3  .

Figure 3  

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Morphological results of PTSMA. Parasternal long axis view (A) and apical four chamber view (B) before (left) and after (right) PTSMA, showing the myectomy like subaortic scar leading to widening of the LVOT. Posterior wall of the left ventricle (LV) also shows regression of hypertrophy (lower arrows in A). Ao, aorta; RV, right ventricle; LA, left atrium.

Figure 4  .

Figure 4  

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Evolution of the LVOTG after PTSMA. *p < 0.05; **p < 0.01; ***p < 0.0001 versus prior measurement.

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These references are in PubMed. This may not be the complete list of references from this article.

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