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The biphasic course of changes of left ventricular outflow gradient after alcohol septal ablation for hypertrophic

Josef Veselka1, Radka Duchonová, Sárka Procházková

  • 1Department of Cardiology, University Hospital Motol, Prague, Czech Republic. Veselka.josef@seznam.cz

Kardiologia Polska
|April 30, 2004
PubMed

Insights

Alcohol septal ablation (PTSMA) initially reduces left ventricular outflow gradient (LVOG) in hypertrophic obstructive cardiomyopathy (HOCM) patients. LVOG rises post-procedure before decreasing by three months, with symptom improvement observed.

Area of Science:

  • Cardiology
  • Interventional Cardiology
  • Cardiac Imaging

Background:

  • Hypertrophic obstructive cardiomyopathy (HOCM) is characterized by a significant left ventricular outflow gradient (LVOG).
  • Alcohol septal ablation (PTSMA) is a treatment option for HOCM aimed at reducing LVOG.
  • The precise early time course of LVOG changes after PTSMA requires further elucidation.

Purpose of the Study:

  • To investigate the temporal changes in LVOG in patients with HOCM undergoing PTSMA.
  • To assess the early hemodynamic effects and symptom relief following PTSMA.

Main Methods:

  • Thirty-nine consecutive HOCM patients (24 women, age 55±14) were enrolled.
  • Maximal LVOG was measured using Doppler echocardiography at baseline, immediately post-PTSMA, and at 3-5 days, 3 weeks, and 3 months.
  • Survival and symptom improvement were also monitored.

Main Results:

  • Baseline LVOG (73±49 mmHg) significantly decreased immediately post-PTSMA (13±16 mmHg, p<0.01).
  • LVOG increased during hospitalization (to 37±35 mmHg, p<0.01) but decreased by 3 weeks (25±12 mmHg, p<0.01) and 3 months (17±14 mmHg, NS).
  • Three-month survival was 97%, with all patients reporting symptom improvement.

Conclusions:

  • PTSMA causes an immediate LVOG reduction due to myocardial stunning and necrosis.
  • A transient increase in LVOG occurs in the early postprocedural period.
  • Short-term follow-up reveals a continuous decrease in LVOG and significant symptom relief in HOCM patients treated with PTSMA.
Abstract

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