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 language | English |
|---|---|
| Pages (from-to) | 200-206 |
| Number of pages | 7 |
| Journal | Italian Heart Journal |
| Volume | 1 |
| Issue number | 3 |
| Publication status | Published - 2000 |
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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 journal › Article
}
TY - JOUR
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
UR - http://www.scopus.com/inward/record.url?scp=0033830711&partnerID=8YFLogxK
UR - http://www.scopus.com/inward/citedby.url?scp=0033830711&partnerID=8YFLogxK
M3 - Article
C2 - 10806987
AN - SCOPUS:0033830711
VL - 1
SP - 200
EP - 206
JO - Italian Heart Journal
JF - Italian Heart Journal
SN - 1129-471X
IS - 3
ER -