© 2004 by European Society of Cardiology
Copyright © 2004, The European Society of Cardiology
Echo-guided percutaneous septal ablation for symptomatic hypertrophic obstructive cardiomyopathy: 7 years of experience
aDepartment of Cardiology, Heart and Diabetes Center North Rhine-Westphalia, Ruhr-University Bochum, Georgstr. 11, D-32545 Bad Oeynhausen, Germany
bMedical Clinic, Leopoldina-Hospital, Schweinfurt, Germany
Received 21 July 2003; received in revised form 22 December 2003; accepted after revision 5 January 2004.
* Corresponding author. Tel.: +49-5731-97-2070; fax: +49-5731-97-1874. lfaber{at}hdz-nrw.de
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Abstract |
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Aims: To analyze the impact of intra-procedural echocardiographic imaging on the interventional strategy in ethanol-induced septal ablation (PTSMA) for symptomatic hypertrophic obstructive cardiomyopathy (HOCM), based on a single-center experience of 7 years.
Methods and results: PTSMA was intended for refractory symptoms in 337 patients (pts.) with HOCM (mean age: 54±15 years), with 312 procedures completed by injection of 2.8±1.2 ml ethanol. In 25 pts. (8%) the intervention was aborted without ethanol injection, mostly because of echocardiographic findings (n = 18/6%). An echocardiography-driven target vessel change was necessary in 33 pts. (11%). In the 312 pts. who received ethanol, permanent pacing was necessary in 22 cases (7%). In-hospital mortality was 1.3% (4 pts.). After 3 months, mean NYHA functional class was reduced from 2.9±0.5 to 1.5±0.6 (p<0.0001) along with a gradient reduction from 60±33 to 13±18 mmHg at rest, and from 120±43 to 38±35 mmHg with provocation (p<0.0001 each). Exercise capacity improved from 94±51 to 115±43 W, peak oxygen consumption from 18±4 to 21±6 ml/kg/min (p<0.01 each). There was no significant difference regarding residual gradients in pts. with different levels of immediate gradient reduction during probatory balloon occlusion.
Conclusions: Catheter-based septal ablation is an effective non-surgical technique for reducing symptoms and outflow gradients in HOCM. Intra-procedural echocardiographic guidance has a cumulative impact on the interventional strategy in about 15–20%, and clearly identifies pts. who should not receive ethanol but undergo a surgical myectomy.
Keywords: Hypertrophic obstructive cardiomyopathy; Percutaneous septal ablation; Left ventricular outflow tract gradient; Myocardial contrast echocardiography
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