title: Echocardiography-guided ethanol septal reduction for hypertrophic obstructive cardiomyopathy.
abstract: BACKGROUND
  Left ventricular outflow tract (LVOT) obstruction is frequently responsible for symptoms in hypertrophic obstructive cardiomyopathy (HOCM). Medical therapy is often not sufficient to control these symptoms, and surgical myotomy-myomectomy is required.
  
  
  RESULTS
  We enrolled 33 symptomatic patients with HOCM and obstruction (>/=40 mm Hg gradient at rest or >/=60 mm Hg dobutamine-provoked). By contrast echocardiography, the bulging septum was localized and infarcted by injection of 2 to 5 mL of absolute ethanol into the septal artery(ies) supplying the hypertrophied area. Baseline echocardiograms with Doppler, myocardial perfusion tomograms, and treadmill exercise or pharmacological testing were compared with those at 6 weeks and 6 months. The mean rise in creatine kinase was 1964+/-796 U. All patients experienced symptomatic relief; NYHA class decreased from 3. 0+/-0.5 to 0.9+/-0.6 (P<0.001). Exercise time increased from 286+/-193 to 421+/-181 seconds (P=0.03). The resting and dobutamine-provoked gradient decreased from 49+/-33 and 96+/-34 mm Hg to 9+/-19 (P<0.001) and 24+/-31 mm Hg (P<0.001), respectively. Echocardiograms repeated at 6 weeks after the procedure showed a 28% reduction in septal thickness and 17% reduction in left ventricular mass. Myocardial perfusion imaging showed a "septal amputation pattern," with scarring in the upper and middle septal areas. Complete heart block developed in 11 patients, who then required permanent pacemaker implantation.
  
  
  CONCLUSIONS
  Echocardiography-guided ethanol septal reduction in patients with HOCM is a safe, minimally invasive procedure that provides symptomatic relief with improved hemodynamic and left ventricular parameters.
authors.affiliation: Baylor College of Medicine, Department of Medicine, Cardiology Section, Houston, Tex., USA.
authors.forename: N M
authors.initials: NM
authors.lastname: Lakkis
authors.forename: S F
authors.initials: SF
authors.lastname: Nagueh
authors.forename: N S
authors.initials: NS
authors.lastname: Kleiman
authors.forename: D
authors.initials: D
authors.lastname: Killip
authors.forename: Z X
authors.initials: ZX
authors.lastname: He
authors.forename: M S
authors.initials: MS
authors.lastname: Verani
authors.forename: R
authors.initials: R
authors.lastname: Roberts
authors.forename: W H
authors.initials: WH
authors.lastname: Spencer
mesh_terms: D000328:Adult; D000368:Aged; D000369:Aged, 80 and over; D002313:Cardiomyopathy, Restrictive / Q000188:drug therapy*; D003402:Creatine Kinase / Q000097:blood; D004452:Echocardiography; D004562:Electrocardiography; D000431:Ethanol / Q000627:therapeutic use*; D005260:Female; D006346:Heart Septum / Q000187:drug effects*; D006439:Hemodynamics / Q000187:drug effects; D006801:Humans; D008297:Male; D008875:Middle Aged; D009336:Necrosis; D015899:Tomography, Emission-Computed, Single-Photon; D014694:Ventricular Outflow Obstruction / Q000150:complications / Q000000981:diagnostic imaging / Q000188:drug therapy*
chemical_list: D000431:Ethanol; D003402:Creatine Kinase