肥厚性閉塞性心筋症－心臓専門医の視点

Left ventricular outflow tract obstruction (LVOTO) commonly occurs in patients with hypertrophic cardiomyopathy (HCM). Management options include drugs-beta-blockers, disopyramide, and myosin inhibitors like mavacamten and aficamten. Septal reduction therapy should be considered for patients who remain symptomatic despite medical therapy. Surgical myectomy is considered the gold standard. However, alcohol septal ablation and surgical myectomy have good and comparable long-term outcomes. Surgical myectomy has a lower incidence of heart block and a lower residual gradient. Surgical myectomy may be preferred in the presence of intrinsic mitral valve disease, papillary muscle abnormalities, markedly thickened septum, multiple levels of obstruction, long length of mid-cavity obstruction, and absence of a suitable septal artery. Alcohol septal ablation should be preferred in individuals who are at high surgical risk. In most other patients, both procedures may be considered, and the choice should be based on available resources and patient preferences.