The biphasic course of changes of left ventricular outflow gradient after alcohol septal ablation for hypertrophic obstructive cardiomyopathy.
OBJECTIVE
Alcohol septal ablation (PTSMA) decreases left ventricular outflow gradient (LVOG) and relieves symptoms in patients with hypertrophic obstructive cardiomyopathy (HOCM). The time course of early changes of LVOG has not been clearly determined up to now.


METHODS
Doppler echocardiography was used to determine the maximal LVOG. Thirty-nine consecutive patients (24 women; age 55+/-14) were examined at baseline, immediately after the procedure, and 3-5 days, 3 weeks and 3 months thereafter.


RESULTS
The baseline LVOG decreased immediately after PTSMA from 73+/-49 mmHg to 13+/-16 mmHg (p<0.01). During the hospital stay (postprocedural period) LVOG increased from 13+/-16 to 37+/-35 mmHg (p<0.01). All the patients were discharged 5-10 days after the procedure. At three-week examination LVOG decreased from 37+/-35 to 25+/-12 mmHg (p<0.01). Three-month survival was 97%. One patient died suddenly one month after PTSMA. At three-month examination LVOG decreased from 25+/-12 to 17+/-14 mmHg (NS). All the patients reported an improvement in symptoms at follow-up.


CONCLUSIONS
The immediate decrease of LVOG after PTSMA procedure caused by myocardial necrosis and stunning, was followed by a significant LVOG increase during the early postprocedural period and continuous LVOG decrease at the short-term follow-up.
Veselka
Josef
J
Department of Cardiology, University Hospital Motol, Prague, Czech Republic. Veselka.josef@seznam.cz
Duchonová
Radka
R
Procházková
Sárka
S
Homolová
Ingrid
I
Pálenícková
Jana
J
Zemánek
David
D
Pernisová
Zuzana
Z
Tesar
David
D
D000368:Aged; D002312:Cardiomyopathy, Hypertrophic / Q000000981:diagnostic imaging / Q000503:physiopathology* / Q000628:therapy*; D015150:Echocardiography, Doppler; D000431:Ethanol / Q000627:therapeutic use*; D005260:Female; D006346:Heart Septum / Q000503:physiopathology*; D006801:Humans; D008297:Male; D008875:Middle Aged; D012597:Sclerosing Solutions / Q000627:therapeutic use; D016019:Survival Analysis; D016896:Treatment Outcome; D014694:Ventricular Outflow Obstruction / Q000000981:diagnostic imaging / Q000503:physiopathology* / Q000628:therapy; D020257:Ventricular Remodeling
D012597:Sclerosing Solutions; D000431:Ethanol