Short-term Efficacy Of Percutaneous Transluminal Septal Myocardium Ablation On Hypertrophic Obstructive Cardiomyopathy

Hypertrophic obstructive cardiomyopathy (HOCM) is the obstructive form of hypertrophic cardiomyopathy, which is defined as a primary, sometimes familial and genetically fixed myocardial hypertrophy. Its pathological behavior is asymmetrical hypertrophic ventricular septal , which leads to dynamic obstruction of left ventricular outflow-tract (LVOT) . Its clinical situations include dyspnea, angina, syncope , and even sudden cardiac death. Percutaneous Transluminal Septal Myocardium Ablation (PTSMA) by alcohol-induced occlusion of septal branch or branches with resulting reduction of left ventricular outflow-tract gradient (LVOTG) is a new treatment option in symptomatic patients with HOCM.The objective of this research is to evaluate the short-term efficacy of PTSMA on sixteen patients with HOCM.Materials and methodsSixteen patients with HOCM underwent PTSMA by Sigwart method from September 1999 to August 2002. LVOTG were measured before and after septal branches occluded by 95% alcohol. EKG was recorded and the complications were observed during and after ablation.ResultsLVOTG was (75.6 ± 21.8) mmHg and( 21.3± 14.7) mmHg before and after ablation respectively (P<0.001); NYHA functional class improved from 3.2 ± 0.6 before ablation to1.8 ± 0.8 two weeks after ablation . CPK and CPK-MB both arise and TNI was positive after ablation. Multiple ventricular extrasystole, nonsustained ventricular tachycardia, bundle branch block and atrio-ventricular block were observed during and after ablation. Permanent complete atrio-ventricular block occurred in one patient and VVI pacemaker was implanted. Inferior wall acute myocardial infarction was found in 2 patients,anterior wall acute myocardial infarction in 1, severe hemodynamic obstruction in 1 and embolism in circumflex branch of left coronary artery in 1.ConclusionsPTSMA can significantly reduce LVOTG and has a satisfactory short-term efficacy in the treatment of HOCM. But the further studies should be done on middle and long-term efficacy and on methods to reduce complications.