Percutaneous alcohol septal ablation following surgical myectomy

The management strategy for hypertrophic obstructive cardiomyopathy generally begins with medical therapy. When this fails to control symptoms, consideration is given to mechanically eliminate the obstruction caused by a thickened and bulging interventricular septum to blood flowing out of the left ventricle. The literature is abundant with data about the safety and efficacy of both surgical myectomy and the newer and now more widely utilized percutaneous alcohol septal ablation procedure. Many cases of successful surgical myectomy performed on patients with recurrent or residual symptoms following percutaneous septal ablation have been published. However, there remains a paucity of information available to the clinician faced with a patient with recurrent or residual symptoms after undergoing surgical myectomy.

We were faced with a series of 2 such patients who presented to our institution after presumed successful myectomy. Both patients had a recurrence of symptoms and a large gradient across the left ventricular outflow tract. Both patients were offered percutaneous alcohol ablation after failure of medical therapy.

Excellent results clinically and echocardiographically were achieved in both patients, with complete symptom relief reported at follow up.

We offer a review of the literature to date and believe our experience demonstrates that percutaneous alcohol septal ablation is an acceptable option that should be offered to patients who have recurrent or incomplete relief of symptoms following presumed successful surgical myectomy.