Key result
Targeted ethanol ablation eliminates refractory VT and reduces gradients in hypertrophic cardiomyopathy.
Why the study?
Percutaneous transluminal septal myocardial ablation is a new treatment option for symptomatic hypertrophic cardiomyopathy with subaortic, SAM-associated obstruction, but its use in mid-ventricular obstruction is less reported.
Case Report (n=2)
No
May offer option for refractory VT and gradients in HCM; extends septal ablation but remains hypothesis-generating.
AIMS: Percutaneous transluminal septal myocardial ablation by alcohol-induced septal branch occlusion is a new treatment option in symptomatic patients with hypertrophic cardiomyopathy and subaortic, SAM-associated obstruction. We report on a patient with mid-ventricular obstruction and echocardiographic-guided reduction of septal hypertrophy. METHODS AND RESULTS: A 52-year-old woman with NYHA class III and recurrent exercise-induced syncope suffered from hypertrophic cardiomyopathy with mid-ventricular obstruction. She had a systolic gradient of 71 mmHg at rest and 153 mmHg post-extrasystole, and diastolic inflow gradient of 20 mmHg. Echo-guided percutaneous transluminal septal myocardial ablation with occlusion of the fourth septal branch resulted in acute reduction and final elimination of systolic, as well as diastolic resting and provocable gradients. Complications were not seen. At 3 months' follow-up the patient was asymptomatic and without further syncopes. CONCLUSIONS: Echocardiographic-guided percutaneous transluminal septal myocardial ablation is able to reduce gradients in hypertrophic cardiomyopathy and mid-ventricular obstruction with consecutive improvement of symptoms.
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Hubert Seggewiß (2000) conducted a case report in Hypertrophic cardiomyopathy with mid-ventricular obstruction (n=2). Percutaneous septal and venous ethanol ablation was evaluated on Reduction in intraventricular pressure gradient and ventricular arrhythmias. Ethanol ablation via septal or coronary venous anatomy eliminated refractory ventricular tachycardia and significantly reduced intraventricular pressure gradients in patients with hypertrophic cardiomyopathy.
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