title: Technology insight: transcoronary ablation of septal hypertrophy.
abstract: Among patients with hypertrophic cardiomyopathy, 5-10% have outflow tract obstruction that results in symptoms refractory to medical therapy. Surgical myectomy has been the gold standard for treating these patients since the 1960s. In the past 10 years, however, alcohol septal ablation has emerged as an alternative procedure. There is growing evidence to indicate that this technique is comparable to surgical myectomy with respect to hemodynamic and functional improvement, although no randomized comparative studies exist to date. The procedure consists of injecting as mall volume of alcohol into a septal perforator under balloon occlusion,preferably after localization of the target septal branch by myocardial contrast echocardiography. Relief of the gradient is instantaneous in about 90% of patients, and further decreases might occur over time. Functional class, exercise capacity and quality of life have been shown to be improved during follow-up. The main risk of the technique is atrioventricular block, which occurs in about 10% of patients. Because of this side-effect and a steep learning curve, the technique should be performed only by experienced operators and on carefully selected patients.
authors.affiliation: University Hospital, Geneva, Switzerland.
authors.forename: Haran
authors.initials: H
authors.lastname: Burri
authors.forename: Ulrich
authors.initials: U
authors.lastname: Sigwart
mesh_terms: D006328:Cardiac Catheterization; D002312:Cardiomyopathy, Hypertrophic / Q000000981:diagnostic imaging / Q000188:drug therapy*; D004452:Echocardiography; D000431:Ethanol / Q000008:administration & dosage / Q000627:therapeutic use*; D006346:Heart Septum / Q000000981:diagnostic imaging / Q000187:drug effects*; D006801:Humans; D007267:Injections; D016896:Treatment Outcome
chemical_list: D000431:Ethanol