[Percutaneous transluminal septal myocardial ablation: early results and long-term follow-up]
Łukasz Tekieli1, Piotr Pieniazek, Piotr Podolec
1Klinika Chorób Serca i Naczyń, Krakowski Szpital Specjalistyczny im. Jana Pawła II, Uniwersytet Jagielloński, Collegium Medicum, Kraków. Itekieli@mp.pl
Background:
Percutaneous transluminal septal myocardial ablation (PTSMA) is becoming an alternative to surgical myectomy in the treatment of severe, drug refractory, hypertrophic obstructive cardiomyopathy (HOCM). The aim of our study was to analyze early results, complications and long-term follow-up in patients after PTSMA.
Methods:
Out of eighteen patients [11 M] initially accepted for PTSMA, the procedure was performed in 12 patients [6 M] age from 22 to 70 y. All the patients underwent clinical evaluation, echocardiography and cardiopulmonary exercise testing (CPX) before the procedure, and after a median of 38 months of observation. In echo-cardiography left ventricle outflow tract gradient (LVOTG) and intraventricular septum diastolic diameter were assessed. The following parameters of CPX were analyzed: exercise duration, anaerobic threshold, peak oxygen consumption, peak exercise heart rate and carbon dioxide ventilating equivalent.
Results:
The procedure was successful in 11 patient. There were 2 acute complications: 3rd degree AV block requiring peacemaker implantation and LVOTG increase with SAM exacerbation requiring urgent cardiosurgical intervention. During long-term follow-up 1 cerebral stroke and 1 death occurred. PTSMA resulted in significant reduction of left ventricle outflow tract gradient (89 +/- 44 vs. 17 +/- 17 mmHg) and intraventricular septum diastolic diameter (24 +/- 4 vs 18 +/- 5 mm) (p < or = 0.01 for both). We also observed improvement of CPX parameters: exercise duration (487 +/- 268 vs. 730 +/- 292 sec), anaerobic threshold (34.3 +/- 8.9 vs. 53.2 +/- 13.4% VO2max predicted), peak oxygen consumption (18.5 +/- 6 vs. 26.8 +/- 10.1 ml/kg/min), peak exercise heart rate (70.3 +/- 8.3 vs. 83.6 +/- 11.7%) and carbon dioxide ventilating equivalent (31 +/- 6.1 vs. 28 +/- 4.8); (p < or = 0.01 for all).
Conclusions:
PTSMA is an effective method of treatment in patients with severe, drug refractory HOCM. PTSMA is safe and is associated with a low percentage of severe complications.
