title: Nonsurgical septal reduction for hypertrophic obstructive cardiomyopathy: outcome in the first series of patients.
abstract: BACKGROUND
  Some patients with hypertrophic obstructive cardiomyopathy may gain symptomatic relief from a reduction in the extent of obstruction to left ventricular outflow. We present the outcome of the first series of patients treated with an alternative method of gradient reduction using catheter techniques.
  
  
  RESULTS
  Eighteen patients were treated with selective intracoronary alcohol injection to induce localized septal infarction. Patients underwent echocardiographic measurement of left ventricular dimensions and Doppler echocardiographic evaluation of left ventricular outflow tract gradients before the procedure, on the first postoperative day, and at a median follow-up of 3 months after the procedure. In addition, patients underwent exercise testing and symptom evaluation before and 3 months after nonsurgical septal reduction. There was a significant reduction in left ventricular outflow tract obstruction after the procedure (preprocedure, 67 mm Hg [95% CI, 48 to 87 mm Hg]; postprocedure, 25 mm Hg [95% CI, 16 to 34 mm Hg]; P=.0006), which persisted at 3-month follow-up (22 mm Hg [95% CI, 12 to 32 mm Hg]; P=.001). This was associated with a significant improvement in symptoms. There was a small but not significant increase in exercise capacity (n=10; preprocedure, 418 seconds [95% CI, 273 to 563 seconds]; postprocedure, 452 seconds [95% CI, 283 to 621 seconds). Left ventricular dimensions were not significantly altered by nonsurgical septal reduction.
  
  
  CONCLUSIONS
  Nonsurgical septal reduction significantly reduces left ventricular outflow tract obstruction and improves symptoms in some patients with hypertrophic obstructive cardiomyopathy. The technique may provide an alternative to surgical myomectomy in selected patients.
authors.affiliation: Royal Brompton Hospital, London, England.
authors.forename: C
authors.initials: C
authors.lastname: Knight
authors.forename: A S
authors.initials: AS
authors.lastname: Kurbaan
authors.forename: H
authors.initials: H
authors.lastname: Seggewiss
authors.forename: M
authors.initials: M
authors.lastname: Henein
authors.forename: M
authors.initials: M
authors.lastname: Gunning
authors.forename: D
authors.initials: D
authors.lastname: Harrington
authors.forename: D
authors.initials: D
authors.lastname: Fassbender
authors.forename: U
authors.initials: U
authors.lastname: Gleichmann
authors.forename: U
authors.initials: U
authors.lastname: Sigwart
mesh_terms: D000293:Adolescent; D000328:Adult; D000368:Aged; D015906:Angioplasty, Balloon, Coronary; D001145:Arrhythmias, Cardiac / Q000209:etiology; D002037:Bundle-Branch Block / Q000209:etiology; D006328:Cardiac Catheterization; D002312:Cardiomyopathy, Hypertrophic / Q000000981:diagnostic imaging / Q000473:pathology / Q000628:therapy*; D003331:Coronary Vessels; D004452:Echocardiography; D004621:Embolization, Therapeutic / Q000379:methods*; D000431:Ethanol / Q000008:administration & dosage / Q000627:therapeutic use; D005080:Exercise Test; D005260:Female; D006346:Heart Septum / Q000473:pathology; D006439:Hemodynamics; D006801:Humans; D008297:Male; D008875:Middle Aged; D010865:Pilot Projects; D016896:Treatment Outcome
chemical_list: D000431:Ethanol