title: The biphasic course of changes of left ventricular outflow gradient after alcohol septal ablation for hypertrophic obstructive cardiomyopathy.
abstract: 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.
authors.affiliation: Department of Cardiology, University Hospital Motol, Prague, Czech Republic. Veselka.josef@seznam.cz
authors.forename: Josef
authors.initials: J
authors.lastname: Veselka
authors.forename: Radka
authors.initials: R
authors.lastname: Duchonová
authors.forename: Sárka
authors.initials: S
authors.lastname: Procházková
authors.forename: Ingrid
authors.initials: I
authors.lastname: Homolová
authors.forename: Jana
authors.initials: J
authors.lastname: Pálenícková
authors.forename: David
authors.initials: D
authors.lastname: Zemánek
authors.forename: Zuzana
authors.initials: Z
authors.lastname: Pernisová
authors.forename: David
authors.initials: D
authors.lastname: Tesar
mesh_terms: 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
chemical_list: D012597:Sclerosing Solutions; D000431:Ethanol