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[Percutaneous transluminal septal ablation with ethanol in hypertrophic obstructive cardiomyopathy: a case report]
M Sakakibara1, S Abe, Y Fusegawa
1Department of Medicine, Tokai University School of Medicine, Kanagawa.
Insights
Nonsurgical septal ablation effectively treated hypertrophic obstructive cardiomyopathy in a patient with persistent symptoms. This less invasive catheterization procedure significantly reduced the left ventricular outflow pressure gradient and improved patient
Area of Science:
- Cardiology
- Interventional Cardiology
- Cardiac Ablation
Background:
- Hypertrophic obstructive cardiomyopathy (HOCM) can cause severe symptoms refractory to medical management.
- Persistent symptoms of dyspnea and chest discomfort significantly impact quality of life in HOCM patients.
- Surgical myectomy is an option but carries significant risks.
Observation:
- A 48-year-old male patient with HOCM experienced persistent severe symptoms despite atenolol and verapamil treatment.
- Nonsurgical septal ablation was performed using percutaneous transluminal coronary angioplasty (PTCA) and alcohol injection into a septal artery under coronary angiography.
- The procedure induced a small septal infarction.
Findings:
- Doppler echocardiography showed a significant reduction in the left ventricular outflow pressure gradient from 108 mmHg to 30 mmHg post-procedure.
- Patient symptoms improved from New York Heart Association class III to II.
- The gradient remained at 0 mmHg at rest 3 months after treatment.
Implications:
- Nonsurgical septal ablation offers a less invasive alternative to surgical myectomy for HOCM.
- This technique demonstrates potential for significant symptom relief and hemodynamic improvement.
- Further evaluation of indications, complications, and long-term efficacy is warranted.
Abstract:
A 48-year-old man with hypertrophic obstructive cardiomyopathy was treated by nonsurgical septal ablation. He had previously received medical treatment using atenolol and verapamil, but severe symptoms of chest discomfort, dyspnea, and shortness of breath had persisted for 2 years. Under coronary angiography control, the first major septal branch of the anterior descending coronary artery was catheterized with a 2.0 mm coaxial percutaneous transluminal coronary angioplasty balloon catheter. After inflation of the balloon, 1.5 ml of absolute alcohol was slowly injected into the septal artery to induce a small septal infarction. The left ventricular outflow pressure gradient was decreased from 108 before to 30 mmHg after the procedure as measured by Doppler echocardiography. His chest symptom improved from New York Heart Association class III to II and left ventricular outflow gradient was maintained at 0 mmHg (at rest) at 3 months after treatment. This is a new, less invasive treatment using catheterization instead of surgical myectomy. The indication, complication, and long-term effect of the treatment must be carefully evaluated, but this is expected to become a useful method.