Percutaneous transluminal septal ablation in hypertrophic obstructive cardiomyopathy

Background: Percutaneous transluminal septal myocardial ablation (PTSMA) by alcohol-induced occlusion of septal branches with resulting reduction of LV outflow-tract gradient (LVOTG) is a new treatment option in symptomatic patients with hypertrophic obstructive cardiomyopathy (HOCM). Methods: In 1996 and 1997 we treated 114 symptomatic patients (56 female; age 53.3 +/- 15.6 years; 5 patients with prior myectomy and 5 with DDD pacer; most in NYHA class ill. Five patients underwent re-PTSMA after failed first treatment. In the first SO patients 1 to 3 septal branches were occluded by injection of 3.4 +/- 1.6 mi absolute alcohol via the central lumen after balloon occlusion of the proximal part: of the septal branch. In the remaining patients myocardial contrast echocardiography was available, so that: only one branch needed to be occluded. Results: LVOTG reduction was achieved in 107 (94%) patients: at rest from 73.8 +/- 36.5 to 18.6 +/-19.7 mmHg (p < 0.00001). Maximal CK rise was 647 +/- 330 U/L, Two (1.8%) patients died during hospital stay. Due to permanent trifascicular block 11 (9.6%) patients required a permanent pacemaker. At 3 months follow-up in 87 patients we observed no cardiac complications, a further LVOTG reduction in 61% patients, an ongoing symptomatic improvement (NYHA I or 11; p<0.0001 vs. pre PTSMA), and significant reduction of the left posterior wall thickness. Conclusions: PTSMA of HOCM results in significant reduction of LVOTG. Careful monitoring during hospital stay is necessary because of the? potential risks of the induced therapeutic infarction. Mid-term follow-up showed ongoing symptomatic improvement without: cardiac complications. Remodeling after circumscribed septal infarction results in further LVOTG reduction in over 50% of the patients.