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Progressive decrease of outflow gradient and septum thickness after percutaneous alcoholization of the
F Airoldi1, C Di Mario, A Catanoso
1Interventional Cardiology Unit, Hospital San Raffaele, Milan, Italy.
Summary
Percutaneous transluminal septal myocardial ablation (PTSMA) effectively reduces the interventricular gradient and septum thickness in hypertrophic obstructive cardiomyopathy. This procedure offers significant symptom relief and improved functional class in patients.
Area of Science:
- Cardiology
- Interventional Cardiology
- Cardiac Surgery
Background:
- Hypertrophic obstructive cardiomyopathy (HOCM) presents a significant clinical challenge.
- Medical management with beta-blockers and verapamil is often insufficient for severe symptoms.
Purpose of the Study:
- To evaluate the immediate and mid-term outcomes of percutaneous transluminal septal myocardial ablation (PTSMA).
- To assess the efficacy of PTSMA in reducing interventricular gradient and septal thickness in HOCM patients.
Main Methods:
- PTSMA was performed on 15 HOCM patients with severe dyspnea (NYHA class III-IV).
- Dehydrated alcohol was selectively infused into septal perforator arteries.
- Repeat alcohol infusions were administered if the intraventricular gradient persisted.
Main Results:
- Significant reduction in peak basal intraventricular gradient from 80 mmHg to 24 mmHg post-procedure (p < 0.01).
- Sustained gradient reduction to 25 mmHg at follow-up (mean 5.1 months).
- Progressive decrease in interventricular septum thickness from 25 mm to 17 mm at follow-up (p < 0.01).
- All patients improved to NYHA functional class I or II.
Conclusions:
- PTSMA is an effective treatment for symptom relief in selected HOCM patients.
- The procedure leads to immediate and sustained reduction in intraventricular gradient.
- PTSMA results in progressive reduction of interventricular septum thickness and improved patient outcomes.