Early Clinical Experience of Percutaneous Transluminal Septal Myocardial Ablation and Septal Myectomy in Patients with Hypertrophic Cardiomyopathy and Severe Left Ventricular Outflow Obstruction.
10.4070/kcj.2003.33.7.599
- Author:
Byung Jin KIM
;
Pyo Won PARK
;
Jeong Euy PARK
- Publication Type:Original Article
- Keywords:
Cardiomyopathy, hypertrophic;
Catheter ablation;
Cardiac surgical procedures
- MeSH:
Bundle-Branch Block;
Cardiac Surgical Procedures;
Cardiomyopathy, Hypertrophic*;
Catheter Ablation;
Coronary Vessels;
Echocardiography;
Electrocardiography;
Ethanol;
Female;
Follow-Up Studies;
Heart;
Humans;
Ventricular Outflow Obstruction*
- From:Korean Circulation Journal
2003;33(7):599-606
- CountryRepublic of Korea
- Language:Korean
-
Abstract:
BACKGROUND AND OBJECTIVES: Percutaneous transluminal septal myocardial ablation (PTSMA) and surgical septal myotomy-myectomy are two treatment options for patients with drug-resistant hypertrophic cardiomyopathy & a left ventricular outflow tract (LVOT) obstruction. The clinical courses, after nonsurgical and surgical septal myotomy-myectomy, are described in 3 patients with hypertrophic cardiomyopathy that continued to be symptomatic following medical management. SUBJECTS AND MEHTODS: 3 patients (2 women, 1 man), with symptomatic drug-refractory obstructive hypertrophic cardiomyopathy, were the subjects of this study. One patient underwent a PTSMA by injection of ethanol into the septal perforator branches of the left anterior descending coronary artery, and 2 a surgical myotomy-myectomy. Examinations of the early and late follow-up echocardiographic results were performed. RESULTS: Both treatment modalities significantly reduced the peak gradient across the LVOT (ablation : 85 to 7.7 mmHg, myectomy : 104 to 10 mmHg), and led to similar improvements in the New York Heart Association class (ablation : NYHA IV to II, myectomy : NYHA III or IV to NYHA I or II). One patient, who underwent a successful PTSMA, showed a temporary right bundle branch block on the ECG for several days following the PTSMA. At the 1-year follow-up, 2 patients were observed to have persistent symptomatic improvements, with no cardiac complications. CONCLUSION: Both a percutaneous septal myocardial ablation and a surgical myotomy-myectomy resulted in similar degrees of significant improvements of the left ventricular outflow tract obstructions, with improvements of the symptoms. Prospective studies are necessary to compare the long-term efficacy of these two treatment modalities.
