Heart 2000;83:326-331 ( March )

Interventional cardiology surgery

Percutaneous transluminal septal myocardial ablation for hypertrophic obstructive cardiomyopathy: long term follow up of the first series of 25 patients L Faber, A Meissner, P Ziemssen, H Seggewiss

Department of Cardiology, Heart Center NRW, Ruhr-University of Bochum, Georgstrasser 11, D-32545 Bad Oeynhausen, Germany

Correspondence to: Prof Dr Seggewiss email: seggewiss.hubert{at}t-online.de

Accepted 20 October 1999

OBJECTIVETo determine the long term outcome in patients treated with percutaneous transluminal septal myocardial ablation (PTSMA) for hypertrophic obstructive cardiomyopathy (HOCM).
DESIGN AND SETTINGObservational, single centre study.
PATIENTS25 patients (13 women, 12 men, mean (SD) age 54.7 (15.0) years) with drug treatment resistant New York Heart Association (NYHA) class 2.8 (0.6) symptoms attributed to a high left ventricular outflow gradient (LVOTG) and a coronary artery anatomy suitable for intervention.
INTERVENTIONPTSMA by injection of 4.1 (2.6) ml of alcohol (96%) into 1.4 (0.6) septal perforator arteries to ablate the hypertrophied interventricular septum.
OUTCOME MEASURESDuring in-hospital follow up, enzyme rise, the frequency of atrioventricular conduction lesions requiring permanent DDD pacing, and in-hospital mortality were assessed. Long term follow up (30 (4) months, range 24-36 months) included symptoms, echocardiographic measurements of left atrial and left ventricular dimensions and function, and LVOTG.
RESULTSMean postinterventional creatine kinase rise was 780 (436) U/l. During PTSMA 13 patents developed total heart block, permanent pacing being necessary in five of them. One 86 year old patient died from ventricular fibrillation associated with intensive treatment ( mimetic and theophylline) for coexistent severe obstructive airway disease. After three months, three patients underwent re-PTSMA because of a dissatisfactory primary result, leading to LVOTG elimination in all of them. During long term follow up, LVOTG showed sustained reduction (3 (6) mm Hg at rest and 12 (19) mm Hg with provocation) associated with stable symptomatic improvement (NYHA class 1.2 (1.0)) and without significant global left ventricular dilatation.
CONCLUSIONSPTSMA is an effective non-surgical technique for reduction of symptoms and LVOTG in HOCM. Prospective, long term observations of larger populations are necessary in order to determine the definitive significance of the procedure.


Keywords: hypertrophic obstructive cardiomyopathy; percutaneous transluminal septal myocardial ablation; left ventricular outflow tract gradient; myocardial contrast echocardiography

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© 2000 by Heart
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