Percutaneous transluminal septal myocardial ablation in hypertrophic obstructive cardiomyopathy: acute and intermediate results in ten patients

Background: In the treatment of Hypertrophic Obstructive Cardiomyopathy, surgical myectomy is considered as standard procedural extension to drug therapy with negatively inotropic agents. Percutaneous Transluminal Septal Myocardial Ablation has been introduced as an alternative to the surgical myectomy for reducing left ventricular outflow tract gradient. We report the acute and intermediate results after percutaneous transluminal septal myocardial ablation in symptomatic patients with hypertrophic obstructive cardiomyopathy. Methods and Results: Ten patients with a mean age of 46.5 ± 6, in NYHA class 2.9 ± 0.31symptoms, resistant to maximal medical management and a coronary artery anatomy suitable for intervention were selected. Percutaneous transluminal septal myocardial ablation was performed by injection of 1± 0.5 mlof 96% alcohol into 1.2 ± 0.42 septal arteries. Mean post-interventional creatine kinase rise was 867.8 ± 301. During the procedure 3 patients developed transient complete heart block, which was present for a mean duration of 11.8 ± 9.7 hours. No patient required permanent pace maker implantation. The left ventricular outflow tract gradient decreased from 98.4 ± 26.8 (64 -160) to 7.6 ±3.5 (0-12) mm of Hg.at rest and after an ectopic from 128 ± 24.7 (98-190) to 17.5 ±5.5 (11-30) mm of Hg. They were discharged at 5± 0.81 days after an uncomplicated hospital course. Clinical and echocardiographic follow up was achieved at the end of 6 months, which showed a further reduction in the gradient from 87.3 ± 11 to 13.4 ± 5.37mm of Hg with NYHA class reduction from 2.9±0.31 to 1. 1±0.31. Conclusion: Percutaneous transluminal septal myocardial ablation is an effective non-surgical technique for reduction of symptoms and left ventricular outflowtract gradient in HOCM.