Alcohol septal ablation for hypertrophic obstructive cardiomyopathy, the first cases series in Thailand
Noppadol Chamnarnphol1, Treechada Wisaratapong
1Division of Cardiology, Department of Internal Medicine, Faculty of Medicine, Prince of Songkla University, Hat Yai, Songkhla 90110, Thailand. cnoppado@hotmail.com
Insights
Alcohol septal ablation (ASA) is a new treatment for hypertrophic obstructive cardiomyopathy (HOCM). This study shows ASA is safe and effective in Thai patients, improving symptoms and reducing outflow tract obstruction.
Area of Science:
- Cardiology
- Interventional Cardiology
- Cardiac Surgery
Background:
- Alcohol septal ablation (ASA) is an emerging percutaneous treatment for hypertrophic obstructive cardiomyopathy (HOCM) unresponsive to medical therapy.
- ASA has not been previously reported in Thailand.
Purpose of the Study:
- To report the first cases of ASA in Thailand for HOCM patients.
- To evaluate the feasibility, safety, and effectiveness of ASA in this population.
Main Methods:
- Retrospective review of clinical and hemodynamic data from four HOCM patients.
- ASA performed without myocardial contrast echocardiography, using anatomical and pressure-guided techniques to select the target septal artery.
Main Results:
- Successful ASA in all four patients.
- Significant reduction in left ventricular outflow tract (LVOT) peak/mean pressure gradients from 105/56 mmHg to 32/18 mmHg immediately post-procedure, and further to 14/8.5 mmHg at 6-12 weeks.
- One patient experienced transient complete atrioventricular block; all patients reported symptomatic improvement.
Conclusions:
- ASA without myocardial contrast echocardiography is feasible, effective, and safe in carefully selected HOCM patients in Thailand.
- This case series represents the first report of ASA for HOCM in Thailand.
Background:
Alcohol septal ablation (ASA) is an emerging percutaneous technique to treat patients with hypertrophic obstructive cardiomyopathy (HOCM) and refractory to medical therapy. ASA in Thailand has never been reported.
Material And Method:
The authors reviewed clinical and hemodynamic data of four patients with HOCM before and after ASA performed between November 2007 and May 2008 in Songklanagarind Hospital.
Results:
ASA without myocardial contrast echocardiography was done successfully in all four patients with HOCM and refractory to medical therapy. The authors used the anatomical characteristics of vessel and pressure-guided technique to identify the optimal septal perforator artery. The averages of left ventricular outflow tract (LVOT) peak/mean pressure gradients (PPG/MPG) were 105/56 before and 32/18 mmHg immediately after ASA, consecutively. There were further falls in LVOT PPG and MPG to averages of 14 and 8.5 mmHg respectively at 6-12 week follow-up. The mean absolute alcohol volume was 2.5 +/- 0.41 ml. Transient complete atrioventricular block occurred in one patient. All patients reported substantial symptomatic improvement.
Conclusion:
The authors reported the first cases series of HOCM patients who underwent ASA in Thailand ASA without myocardial contrast echocardiography in carefully selected patient is feasible, effective, and safe.
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