Key result
Percutaneous transluminal septal alcoholization significantly reduced the baseline intraventricular pressure gradient from 67.6 mmHg to 3.8 mmHg (p<0.005).
Why the study?
Does percutaneous transluminal septal alcoholization reduce intraventricular pressure gradients in patients with refractory hypertrophic obstructive cardiomyopathy?
Observational (n=22)
Does percutaneous transluminal septal alcoholization reduce intraventricular pressure gradients in patients with refractory hypertrophic obstructive cardiomyopathy?
Percutaneous transluminal septal alcoholization is an effective procedure that significantly reduces intraventricular pressure gradients and septal thickness in patients with refractory hypertrophic obstructive cardiomyopathy.
May support gradient reduction in refractory HOCM; leaves open need for controlled trials before wider use.
OBJECTIVE: To analyze the efficacy of percutaneous transluminal septal alcoholization in the treatment of refractory obstructive hypertrophic cardiomyopathy (HOC). METHODS: The patients were referred for alcoholization after Doppler echocardiography. Before and after alcoholization, the intraventricular pressure gradient was recorded. Alcoholization was performed with a 3mL injection of absolute alcohol through a coronary angioplasty balloon catheter. The procedure was concluded after a significant reduction or abolition of the pressure gradient. RESULTS: Of 22 patients, 18 (81.8%) successfully concluded the procedure with a reduction in intraventricular pressure gradient at baseline (from 67.6+/-24.2 mmHg to 3.8+/-1.9 mmHg, p<0.005) and after extrasystole (from 110.4+/-24.2 mmHg to 9.6+/-2.6 mm Hg, p<0.005). A significant reduction in mean interventricular septal thickness (from 2+/-0.3 mm to 1.7+/-0.2 mm, p<0.005) and in peak pressure gradient (from 90.7+/-23.5 mmHg to 6.1+/-1.4 mmHg, p<0.005) was observed on Doppler echocardiography after 6 months, when all patients were in functional class I. The most frequent acute complication, present in 11% of the patients, was the need for definitive pacing implantation. Relapse of the symptoms and reappearance of the pressure gradient occurred in 16.6% of the patients. One patient (5.5%) died probably due to a diffuse coronary spasm prior to the procedure, and another died suddenly on late follow-up. CONCLUSION: Percutaneous transluminal septal alcoholization is effective and safe in the treatment of HOC.
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Osterne et al. (2003) conducted an observational in refractory obstructive hypertrophic cardiomyopathy (HOC) (n=22). Percutaneous transluminal septal alcoholization vs. Baseline (pre-procedure) was evaluated on intraventricular pressure gradient at baseline (p=<0.005). Percutaneous transluminal septal alcoholization significantly reduced the baseline intraventricular pressure gradient from 67.6 mmHg to 3.8 mmHg (p<0.005).
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