Evaluation of left ventricular outflow tract area after septal reduction in obstructive hypertrophic cardiomyopathy: a real-time 3-dimensional echocardiographic study.
BACKGROUND
The comparative impact of percutaneous alcohol septal reduction (ASR) and surgical myectomy on the left ventricular outflow tract (LVOT) area in patients with obstructive hypertrophic cardiomyopathy (HC) is not well defined. Real-time 3-dimensional echocardiography (RT3DE) provides accurate information about the LVOT geometry and shape. We aimed to analyze the change in LVOT area after septal reduction interventions in patients with obstructive HC using RT3DE.


METHODS
Thirty-one HC patients (mean age 53 +/- 17 years) undergoing ASR (n = 14) or myectomy (n = 17) were studied at baseline and during follow-up with RT3DE. LVOT area was measured after observing the LVOT in the 3D space as the smallest area during midsystole. LVOT pressure gradients were determined by conventional continuous wave Doppler.


RESULTS
Overall, LVOT area increased from 0.86 +/- 0.20 to 2.50 +/- 0.88 cm2 (P < .01), and the resting LVOT pressure gradient decreased from 64 +/- 41 to 16 +/- 10 mm Hg (P < .01) after a median follow-up of 3 months after intervention (range 1-24 months). A similar significant decrease in LVOT pressure gradients was seen in myectomy and ASR groups (from 62 +/- 39 to 12 +/- 5 mm Hg and from 67 +/- 43 to 21 +/- 14 mm Hg, respectively, P < .01 in between each group, and P = NS between both groups). However, the increase in LVOT area was greater in myectomy than in ASR group (from 0.81 +/- 0.22 to 2.90 +/- 0.64 cm2 and 0.93 +/- to 0.16 to 2.02 +/- 0.92 cm2, respectively, P < .01 between both groups).


CONCLUSIONS
RT3DE demonstrated an effective increase in LVOT area after both ASR and myectomy. This technique may be useful for assessing the results of septal reduction in patients with obstructive HC.
Sitges
Marta
M
Department of Cardiovascular Medicine, The Cleveland Clinic Foundation, Cleveland, Ohio 44195, USA.
Qin
Jian Xin
JX
Lever
Harry M
HM
Bauer
Fabrice
F
Drinko
Jeannie K
JK
Agler
Deborah A
DA
Kapadia
Samir R
SR
Tuzcu
E Murat
EM
Smedira
Nicholas G
NG
Lytle
Bruce W
BW
Thomas
James D
JD
Shiota
Takahiro
T
D000293:Adolescent; D000328:Adult; D000368:Aged; D000369:Aged, 80 and over; D000800:Angioplasty, Balloon; D006348:Cardiac Surgical Procedures; D002312:Cardiomyopathy, Hypertrophic / Q000000981:diagnostic imaging* / Q000473:pathology* / Q000628:therapy; D019560:Echocardiography, Three-Dimensional; D000431:Ethanol; D005260:Female; D006801:Humans; D008297:Male; D008875:Middle Aged; D012039:Regional Blood Flow
D000431:Ethanol