Progressive decrease of outflow gradient and septum thickness after percutaneous alcoholization of the interventricular septum in hypertrophic obstructive cardiomyopathy

F. Airoldi, C. Di Mario, A. Catanoso, A. Dharmadhikari, V. Tzifos, A. Anzuini, M. Carlino, C. Briguori, M. Montorfano, M. Vaghetti, S. Tolaro, A. Colombo

Research output: Contribution to journalArticle

Abstract

Background: The aim of this study was to evaluate the immediate- and mid-term results of percutaneous transluminal septal myocardial ablation (PTSMA) of the interventricular septum performed in 15 consecutive patients with hypertrophic obstructive cardiomyopathy between 1996 and 1999. Methods: Prior to intervention, all patients (7 males, 8 females, mean age 62 ± 11 years) complained of severe dyspnea (NYHA functional class III-IV) despite medical treatment with β-blockers and/or verapamil. Family history of hypertrophic cardiomyopathy was present in 2 cases. Dehydrated alcohol (4.8 ± 1.5 ml/pt) was selectively infused into the first septal perforator artery through over-the-wire balloon catheters. In 5 patients a second or a third septal branch was treated because the intraventricular gradient persisted above 50 mmHg after the initial alcohol infusion. Results: Alcohol infusion induced an average peak creatine phosphokinase level of 1524 ± 427 IU/l. No iterating ventricular arrhythmias occurred during the procedure or in the 2-3 days of continuous ECG monitoring after the procedure. Two patients (13%) developed a complete atrioventricular block after the procedure, requiring permanent double-chamber pacing. Electrocardiographic changes included a > 2 mm ST segment elevation and transient right bundle branch block or left anterior/left posterior hemiblock in all patients. Peak basal intraventricular gradient decreased from 80 ± 27 to 24 ± 27 mmHg (p <0.01) during cardiac catheterization and from 81 ± 27 to 35 ± 25 mmHg (p <0.01) at the echocardiograpic control performed during the hospital stay. At follow-up (mean 5.1 ± 3.6 months), all patients were in NYHA functional class I or II. Repeat echocardiography showed a further significant decrease in intraventricular gradient to 25 ± 26 mmHg (p <0.01) and a progressive decrease in intraventricular septum thickness (25 ± 5 mm before treatment, 21 ± 6 mm before hospital discharge, 17 ± 3 mm at follow-up, p <0.01). Conclusions: PTSMA of the intraventricular septum effectively relieves symptoms in selected patients with hypertrophic obstructive cardiomyopathy. The immediate decrease in intraventricular gradient is followed by a further decline at follow-up with a progressive reduction in the intraventricular septum thickness.

Original languageEnglish
Pages (from-to)200-206
Number of pages7
JournalItalian Heart Journal
Volume1
Issue number3
Publication statusPublished - 2000

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Hypertrophic Cardiomyopathy
Alcohols
Bundle-Branch Block
Atrioventricular Block
Cardiac Catheterization
Creatine Kinase
Verapamil
Dyspnea
Echocardiography
Cardiac Arrhythmias
Length of Stay
Electrocardiography
Catheters
Arteries
Therapeutics

Keywords

  • Hypertrophic cardiomyopathy
  • Intraventricular gradient
  • Septal alcoholization

ASJC Scopus subject areas

  • Cardiology and Cardiovascular Medicine

Cite this

Progressive decrease of outflow gradient and septum thickness after percutaneous alcoholization of the interventricular septum in hypertrophic obstructive cardiomyopathy. / Airoldi, F.; Di Mario, C.; Catanoso, A.; Dharmadhikari, A.; Tzifos, V.; Anzuini, A.; Carlino, M.; Briguori, C.; Montorfano, M.; Vaghetti, M.; Tolaro, S.; Colombo, A.

In: Italian Heart Journal, Vol. 1, No. 3, 2000, p. 200-206.

Research output: Contribution to journalArticle

Airoldi, F, Di Mario, C, Catanoso, A, Dharmadhikari, A, Tzifos, V, Anzuini, A, Carlino, M, Briguori, C, Montorfano, M, Vaghetti, M, Tolaro, S & Colombo, A 2000, 'Progressive decrease of outflow gradient and septum thickness after percutaneous alcoholization of the interventricular septum in hypertrophic obstructive cardiomyopathy', Italian Heart Journal, vol. 1, no. 3, pp. 200-206.
Airoldi, F. ; Di Mario, C. ; Catanoso, A. ; Dharmadhikari, A. ; Tzifos, V. ; Anzuini, A. ; Carlino, M. ; Briguori, C. ; Montorfano, M. ; Vaghetti, M. ; Tolaro, S. ; Colombo, A. / Progressive decrease of outflow gradient and septum thickness after percutaneous alcoholization of the interventricular septum in hypertrophic obstructive cardiomyopathy. In: Italian Heart Journal. 2000 ; Vol. 1, No. 3. pp. 200-206.
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abstract = "Background: The aim of this study was to evaluate the immediate- and mid-term results of percutaneous transluminal septal myocardial ablation (PTSMA) of the interventricular septum performed in 15 consecutive patients with hypertrophic obstructive cardiomyopathy between 1996 and 1999. Methods: Prior to intervention, all patients (7 males, 8 females, mean age 62 ± 11 years) complained of severe dyspnea (NYHA functional class III-IV) despite medical treatment with β-blockers and/or verapamil. Family history of hypertrophic cardiomyopathy was present in 2 cases. Dehydrated alcohol (4.8 ± 1.5 ml/pt) was selectively infused into the first septal perforator artery through over-the-wire balloon catheters. In 5 patients a second or a third septal branch was treated because the intraventricular gradient persisted above 50 mmHg after the initial alcohol infusion. Results: Alcohol infusion induced an average peak creatine phosphokinase level of 1524 ± 427 IU/l. No iterating ventricular arrhythmias occurred during the procedure or in the 2-3 days of continuous ECG monitoring after the procedure. Two patients (13{\%}) developed a complete atrioventricular block after the procedure, requiring permanent double-chamber pacing. Electrocardiographic changes included a > 2 mm ST segment elevation and transient right bundle branch block or left anterior/left posterior hemiblock in all patients. Peak basal intraventricular gradient decreased from 80 ± 27 to 24 ± 27 mmHg (p <0.01) during cardiac catheterization and from 81 ± 27 to 35 ± 25 mmHg (p <0.01) at the echocardiograpic control performed during the hospital stay. At follow-up (mean 5.1 ± 3.6 months), all patients were in NYHA functional class I or II. Repeat echocardiography showed a further significant decrease in intraventricular gradient to 25 ± 26 mmHg (p <0.01) and a progressive decrease in intraventricular septum thickness (25 ± 5 mm before treatment, 21 ± 6 mm before hospital discharge, 17 ± 3 mm at follow-up, p <0.01). Conclusions: PTSMA of the intraventricular septum effectively relieves symptoms in selected patients with hypertrophic obstructive cardiomyopathy. The immediate decrease in intraventricular gradient is followed by a further decline at follow-up with a progressive reduction in the intraventricular septum thickness.",
keywords = "Hypertrophic cardiomyopathy, Intraventricular gradient, Septal alcoholization",
author = "F. Airoldi and {Di Mario}, C. and A. Catanoso and A. Dharmadhikari and V. Tzifos and A. Anzuini and M. Carlino and C. Briguori and M. Montorfano and M. Vaghetti and S. Tolaro and A. Colombo",
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T1 - Progressive decrease of outflow gradient and septum thickness after percutaneous alcoholization of the interventricular septum in hypertrophic obstructive cardiomyopathy

AU - Airoldi, F.

AU - Di Mario, C.

AU - Catanoso, A.

AU - Dharmadhikari, A.

AU - Tzifos, V.

AU - Anzuini, A.

AU - Carlino, M.

AU - Briguori, C.

AU - Montorfano, M.

AU - Vaghetti, M.

AU - Tolaro, S.

AU - Colombo, A.

PY - 2000

Y1 - 2000

N2 - Background: The aim of this study was to evaluate the immediate- and mid-term results of percutaneous transluminal septal myocardial ablation (PTSMA) of the interventricular septum performed in 15 consecutive patients with hypertrophic obstructive cardiomyopathy between 1996 and 1999. Methods: Prior to intervention, all patients (7 males, 8 females, mean age 62 ± 11 years) complained of severe dyspnea (NYHA functional class III-IV) despite medical treatment with β-blockers and/or verapamil. Family history of hypertrophic cardiomyopathy was present in 2 cases. Dehydrated alcohol (4.8 ± 1.5 ml/pt) was selectively infused into the first septal perforator artery through over-the-wire balloon catheters. In 5 patients a second or a third septal branch was treated because the intraventricular gradient persisted above 50 mmHg after the initial alcohol infusion. Results: Alcohol infusion induced an average peak creatine phosphokinase level of 1524 ± 427 IU/l. No iterating ventricular arrhythmias occurred during the procedure or in the 2-3 days of continuous ECG monitoring after the procedure. Two patients (13%) developed a complete atrioventricular block after the procedure, requiring permanent double-chamber pacing. Electrocardiographic changes included a > 2 mm ST segment elevation and transient right bundle branch block or left anterior/left posterior hemiblock in all patients. Peak basal intraventricular gradient decreased from 80 ± 27 to 24 ± 27 mmHg (p <0.01) during cardiac catheterization and from 81 ± 27 to 35 ± 25 mmHg (p <0.01) at the echocardiograpic control performed during the hospital stay. At follow-up (mean 5.1 ± 3.6 months), all patients were in NYHA functional class I or II. Repeat echocardiography showed a further significant decrease in intraventricular gradient to 25 ± 26 mmHg (p <0.01) and a progressive decrease in intraventricular septum thickness (25 ± 5 mm before treatment, 21 ± 6 mm before hospital discharge, 17 ± 3 mm at follow-up, p <0.01). Conclusions: PTSMA of the intraventricular septum effectively relieves symptoms in selected patients with hypertrophic obstructive cardiomyopathy. The immediate decrease in intraventricular gradient is followed by a further decline at follow-up with a progressive reduction in the intraventricular septum thickness.

AB - Background: The aim of this study was to evaluate the immediate- and mid-term results of percutaneous transluminal septal myocardial ablation (PTSMA) of the interventricular septum performed in 15 consecutive patients with hypertrophic obstructive cardiomyopathy between 1996 and 1999. Methods: Prior to intervention, all patients (7 males, 8 females, mean age 62 ± 11 years) complained of severe dyspnea (NYHA functional class III-IV) despite medical treatment with β-blockers and/or verapamil. Family history of hypertrophic cardiomyopathy was present in 2 cases. Dehydrated alcohol (4.8 ± 1.5 ml/pt) was selectively infused into the first septal perforator artery through over-the-wire balloon catheters. In 5 patients a second or a third septal branch was treated because the intraventricular gradient persisted above 50 mmHg after the initial alcohol infusion. Results: Alcohol infusion induced an average peak creatine phosphokinase level of 1524 ± 427 IU/l. No iterating ventricular arrhythmias occurred during the procedure or in the 2-3 days of continuous ECG monitoring after the procedure. Two patients (13%) developed a complete atrioventricular block after the procedure, requiring permanent double-chamber pacing. Electrocardiographic changes included a > 2 mm ST segment elevation and transient right bundle branch block or left anterior/left posterior hemiblock in all patients. Peak basal intraventricular gradient decreased from 80 ± 27 to 24 ± 27 mmHg (p <0.01) during cardiac catheterization and from 81 ± 27 to 35 ± 25 mmHg (p <0.01) at the echocardiograpic control performed during the hospital stay. At follow-up (mean 5.1 ± 3.6 months), all patients were in NYHA functional class I or II. Repeat echocardiography showed a further significant decrease in intraventricular gradient to 25 ± 26 mmHg (p <0.01) and a progressive decrease in intraventricular septum thickness (25 ± 5 mm before treatment, 21 ± 6 mm before hospital discharge, 17 ± 3 mm at follow-up, p <0.01). Conclusions: PTSMA of the intraventricular septum effectively relieves symptoms in selected patients with hypertrophic obstructive cardiomyopathy. The immediate decrease in intraventricular gradient is followed by a further decline at follow-up with a progressive reduction in the intraventricular septum thickness.

KW - Hypertrophic cardiomyopathy

KW - Intraventricular gradient

KW - Septal alcoholization

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