[Clinical and echocardiographic follow-up of patients with hypertrophic obstructive cardiomyopathy treated by percutaneous septal ablation].
OBJECTIVE
Alcohol septal ablation is a therapeutic option for patients with hypertrophic obstructive cardiomyopathy who remain symptomatic despite medical treatment. Our aim was to monitor clinical and echocardiographic progression in patients with hypertrophic obstructive cardiomyopathy treated by septal ablation at our center.


METHODS
Thirty-five septal ablations were performed in 34 patients (79% male) who had symptomatic hypertrophic obstructive cardiomyopathy despite optimum medical treatment. The procedure was successful in 32 (i.e., the reduction in left ventricular outflow tract pressure gradient, or LVOTPG, was >50%). During clinical and echocardiographic follow-up, New York Heart Association (NYHA) functional class and LVOTPG were monitored.


RESULTS
The patients' mean age was 63 (12) years. The mean follow-up period was 9 (3) months. Immediately after septal ablation, LVOTPG decreased significantly, from 74.2 (25.3) mm Hg to 26 (25) mm Hg (P<.001), and remained low throughout follow-up. Moreover, echocardiography showed that the interventricular septum thickness also decreased during follow-up, from 19 (3) mm to 15 (2) mm (P<.0001). A significant improvement in NYHA functional class (from 93% in class III-IV to 84% in class I-II) was also observed. Two deaths occurred within 48 hours after the procedure. The most frequent complication was complete heart block (20%; n=6).


CONCLUSIONS
Alcohol septal ablation is effective in patients with hypertrophic obstructive cardiomyopathy who remain symptomatic despite medical treatment. However, the procedure is associated with a significant rate of complications and should, therefore, be reserved for selected patients, in particular for elderly patients and those with comorbid conditions.
Delgado
Victoria
V
Institut Clínic del Tórax, Hospital Clínic, IDIBAPS (Institut d'Investigacions Biomèdiques August Pi i Sunyer), Facultad de Medicina, Universidad de Barcelona, Barcelona, Spain.
Sitges
Marta
M
Andrea
Rut
R
Rivera
Socorro
S
Masotti
Mónica
M
Francino
Antonio
A
Azqueta
Manuel
M
Paré
Carles
C
Betriu
Amadeo
A
D000328:Adult; D000368:Aged; D000369:Aged, 80 and over; D002312:Cardiomyopathy, Hypertrophic / Q000000981:diagnostic imaging* / Q000628:therapy*; D002404:Catheterization; D000431:Ethanol / Q000008:administration & dosage*; D005260:Female; D005500:Follow-Up Studies; D006801:Humans; D008297:Male; D008875:Middle Aged; D014463:Ultrasonography
D000431:Ethanol