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[Catheter treatment of hypertrophic obstructive cardiomyopathy]
U Gleichmann1, H Seggewiss, L Faber
1Kardiologische Klinik, Herz- und Diabeteszentrum Nordrhein-Westfalen, Universitätsklinik der Ruhr-Universität Bochum, Bad Oeynhausen.
Insights
This study introduces a new transcatheter myocardial reduction technique for hypertrophic obstructive cardiomyopathy (HOCM). The procedure effectively reduced the left ventricular outflow tract (LVOT) gradient, offering a less invasive treatment option.
Area of Science:
- Cardiology
- Interventional Cardiology
- Medical Devices
Background:
- Hypertrophic obstructive cardiomyopathy (HOCM) presents a significant clinical challenge, often requiring invasive interventions.
- Current treatments include medication, surgical myectomy, and DDD pacemaker implantation.
- A novel transcatheter myocardial reduction technique is being evaluated as an alternative approach.
Purpose of the Study:
- To assess the efficacy and safety of a new transcatheter myocardial reduction method for treating HOCM.
- To evaluate the reduction in left ventricular outflow tract (LVOT) gradient using this minimally invasive technique.
Main Methods:
- Six patients with HOCM and moderate heart failure underwent transcatheter myocardial reduction.
- The procedure involved atrial transseptal puncture and selective occlusion of septal branches of the left coronary artery using alcohol.
- Left ventricular outflow tract (LVOT) gradient was measured before and after the intervention.
Main Results:
- Significant reduction in LVOT gradient was observed, from a mean of 57.8 mm Hg at rest to 11.3 mm Hg, and postextrasystolic from 131.0 mm Hg to 44.0 mm Hg.
- Patients experienced transient angina and elevated creatine kinase levels post-procedure.
- Three patients developed temporary atrioventricular block requiring pacemaker support.
Conclusions:
- Transcatheter myocardial reduction offers a nonsurgical option for reducing septal myocardium and the LVOT gradient in HOCM.
- Further long-term studies with larger patient cohorts are necessary to establish its definitive role in HOCM management.
Basic Problems And Objective:
In addition to medication with negative inotropic drugs, surgical myectomy and DDD pacemaker implantation are standard procedures in the treatment of hypertrophic obstructive cardiomyopathy (HOCM). In a preliminary series the results obtained with a recently described method, consisting of transcatheter myocardial reduction, are evaluated.
Patients And Methods:
Six patients (two women, four men; mean age 52.7 [44-68] years), who remained in moderate heart failure despite medical treatment, underwent the procedure. After atrial transseptal puncture (via a catheter introduced percutaneously into the femoral vein) the left ventricular outflow tract (LVOT) gradient was measured at rest and after 5-minute balloon occlusion of the first septal branch of the left coronary artery. After demonstration of significant reduction of the gradient by the occlusion, one (n = 3) or two (n = 3) septal branches were occluded by the injection of 2-5 ml of 96% alcohol.
Results:
The LVOT gradient was reduced from 57.8 +/- 22.4 (38-97) mm Hg to 11.3 +/- 8.6 (0-21) mm Hg and postextrasystolic from 131.0 +/- 40.7 (78-198) mm Hg to 44.0 +/- 35.6 (19-69) mm Hg. All patients had angina for 24 hours after the procedure. Maximal rise in creatine kinase activity was 982 +/- 589 (392-1729) U/l after 8.0 +/- 3.9 (4-15) hours. In three patients transitory complete atrioventricular block developed 10 min to 5 days later, requiring temporary pacemaker implantation. The further course was without complication in all patients and they were discharged after 7.5 +/- 1.8 (6-11) days.
Conclusion:
The described catheter method provides a nonsurgical means of reducing the amount of septal myocardium with subsequent reduction of the LVOT gradient in HOCM. Long-term observation in a larger group of patients and comparison with conventional forms of treatment are required to determined the method's ultimate place in the treatment of HOCM.