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Rigopoulos AG, Sakellaropoulos S, Ali M, Mavrogeni S, Manginas A, Pauschinger M, Noutsias M. Transcatheter septal ablation in hypertrophic obstructive cardiomyopathy: a technical guide and review of published results. Heart Fail Rev 2019; 23:907-917. [PMID: 29736811 DOI: 10.1007/s10741-018-9706-z] [Citation(s) in RCA: 11] [Impact Index Per Article: 2.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/23/2022]
Abstract
Transcatheter alcohol septal ablation (ASA) treatment of symptomatic patients with hypertrophic obstructive cardiomyopathy (HOCM) is based on the existence and degree of intraventricular obstruction. Patients with significant gradient and symptoms who do not respond to optimal medical therapy are eligible to gradient reduction through a surgical (septal myectomy) or a transcatheter (alcohol septal ablation) septal reduction. The latter encompasses occlusion of a septal branch perfusing the hypertrophied septum, which is involved in the generation of obstruction, by injecting ethanol into the supplying septal branch(es). ASA has been established as a highly effective and safe method and has outnumbered the surgical gold standard. Although the technique is straightforward, patient selection and some technical details may influence the efficacy and safety of the procedure. The technique is based on echocardiographic contrast guidance, which allows accurate target septal branch selection and optimisation of the result. Published long-term results from high-volume centres have confirmed the effectiveness of ASA and have shown excellent survival, which is comparable to that in the general population. Choice and performance of the surgical or interventional treatment should be implemented in highly specialised centres in terms of a heart-team approach, taking notice of anatomic characteristics as well as comorbidities. Involvement of all cases in international registries may reveal the individual merits and indications for the surgical and interventional treatment in HOCM.
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Affiliation(s)
- Angelos G Rigopoulos
- Mid-German Heart Center, Department of Internal Medicine III, Division of Cardiology, Angiology and Intensive Medical Care, University Hospital Halle, Martin-Luther-University Halle, Ernst-Grube-Strasse 40, D-06120, Halle, Germany.
| | - Stefanos Sakellaropoulos
- Mid-German Heart Center, Department of Internal Medicine III, Division of Cardiology, Angiology and Intensive Medical Care, University Hospital Halle, Martin-Luther-University Halle, Ernst-Grube-Strasse 40, D-06120, Halle, Germany
| | - Muhammad Ali
- Mid-German Heart Center, Department of Internal Medicine III, Division of Cardiology, Angiology and Intensive Medical Care, University Hospital Halle, Martin-Luther-University Halle, Ernst-Grube-Strasse 40, D-06120, Halle, Germany
| | - Sophie Mavrogeni
- Onassis Cardiac Surgery Center, 50 Esperou Street, 175-61, Palaeo Faliro, Athens, Greece
| | - Athanassios Manginas
- Interventional Cardiology and Cardiology Department, Mediterraneo Hospital, Ilias Street 8-12, 16675, Glyfada, Greece
| | - Matthias Pauschinger
- Department of Cardiology, Internal Medicine 8, Paracelsus Medical University, Nuremberg General Hospital, Nuremberg, Germany
| | - Michel Noutsias
- Mid-German Heart Center, Department of Internal Medicine III, Division of Cardiology, Angiology and Intensive Medical Care, University Hospital Halle, Martin-Luther-University Halle, Ernst-Grube-Strasse 40, D-06120, Halle, Germany
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Rigopoulos AG, Seggewiss H. Twenty Years of Alcohol Septal Ablation in Hypertrophic Obstructive Cardiomyopathy. Curr Cardiol Rev 2016; 12:285-296. [PMID: 25563291 PMCID: PMC5304253 DOI: 10.2174/1573403x11666150107160344] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/06/2014] [Revised: 12/14/2014] [Accepted: 12/17/2014] [Indexed: 01/28/2023] Open
Abstract
Hypertrophic obstructive cardiomyopathy is the most common genetic cardiac disease and is generally characterised by asymmetric septal hypertrophy and intraventricular obstruction. Patients with severe obstruction and significant symptoms that persist despite optimal medical treatment are candidates for an invasive septal reduction therapy. Twenty years after its introduction, percutaneous transluminal alcohol septal ablation has been increasingly preferred for septal reduction in patients with drug refractory hypertrophic obstructive cardiomyopathy. Myocardial contrast echocardiography and injection of reduced alcohol volumes have increased safety, while efficacy is comparable to the surgical alternative, septal myectomy, which has for decades been regarded as the 'gold standard' treatment. Data on medium- and long-term survival show improved prognosis with survival being similar to the general population. Current guidelines have supported its use by experienced operators in centres specialised in the treatment of patients with hypertrophic obstructive cardiomyopathy.
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Affiliation(s)
- Angelos G Rigopoulos
- Medizinische Klinik 1, Leopoldina Krankenhaus Schweinfurt, Gustav-Adolf-Str. 8, 97422 Schweinfurt, Germany.
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Sathyamurthy I, Nayak R, Oomman A, Subramanyan K, Kalarical MS, Mao R, Ramachandran P. Alcohol septal ablation for hypertrophic obstructive cardiomyopathy - 8 years follow up. Indian Heart J 2013; 66:57-63. [PMID: 24581097 PMCID: PMC5125590 DOI: 10.1016/j.ihj.2013.12.008] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/22/2013] [Revised: 11/18/2013] [Accepted: 12/04/2013] [Indexed: 11/30/2022] Open
Abstract
Background Alcohol septal ablation is emerging as an alternative to surgical myectomy in the management of symptomatic cases of Hypertrophic obstructive cardiomyopathy (HOCM). This involves injection of absolute alcohol into 1st septal perforator thereby producing myocardial necrosis with resultant septal remodelling within 3–6 months. This results in reduction of septal thickness and LV outflow gradients with improvement in symptoms. Methods Fifty three patients had undergone alcohol septal ablation, there were 2 early and 2 late deaths and 4 patients lost to follow up. Forty-five (85%) of them were followed up to a mean period of 96 ± 9.2 months. Clinical, ECG, and Echocardiographic parameters were evaluated during follow up. Results Only 4 out of 51 patients remained in NYHA class III or IV at the end of 6 months. Significant reduction of LV outflow gradients (79 ± 35 to 34 ± 23 mmHg) and septal thickness (23 ± 4.7 mm to 19 ± 3 mm) were observed during 6 months follow up. Beyond 6 months there was no further decrease in either septal thickness or LVOT gradients noted. Ten percent of patients needed pacemaker implantation. There was 92% survival at the end of 8 years. Conclusion Alcohol septal ablation is a safe and effective nonsurgical procedure for the treatment of HOCM. By minimizing the amount of alcohol to ≤2 ml, one can reduce complications and mortality. The long-term survival is gratifying.
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Affiliation(s)
- I Sathyamurthy
- Sr. Interventional Cardiologist & Director, Dept of Cardiology, Apollo Hospitals, Chennai 600006, India.
| | - Rajeshwari Nayak
- Sr. Interventional Cardiologist, Apollo Hospitals, Chennai 600006, India
| | - Abraham Oomman
- Sr. Interventional Cardiologist, Apollo Hospitals, Chennai 600006, India
| | - K Subramanyan
- Sr. Interventional Cardiologist, Apollo Hospitals, Chennai 600006, India
| | | | - Robert Mao
- Sr. Interventional Cardiologist, Apollo Hospitals, Chennai 600006, India
| | - P Ramachandran
- Sr. Interventional Cardiologist, Apollo Hospitals, Chennai 600006, India
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Jacoby DL, DePasquale EC, McKenna WJ. Hypertrophic cardiomyopathy: diagnosis, risk stratification and treatment. CMAJ 2012; 185:127-34. [PMID: 23109605 DOI: 10.1503/cmaj.120138] [Citation(s) in RCA: 24] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/02/2023] Open
Affiliation(s)
- Daniel L Jacoby
- Division of Cardiovascular Medicine, Yale University School of Medicine, New Haven, CT, USA.
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Abstract
Percutaneous septal ablation has emerged as a less invasive treatment of symptomatic patients with hypertrophic obstructive cardiomyopathy (HOCM). In the past decade, the availability of this sophisticated technique has revived the interest of cardiologists in left ventricular outflow tract obstruction, which led to the recognition that most patients with HCM have the obstructive type. Follow-up studies have already shown the safety and efficacy of the procedure, which offers symptomatic relief in most patients. Long-term survival is comparable to historical reports after surgical myectomy. Complications are rare and can be further reduced with increased experience of the operators, and the theoretical concern for possible ventricular arrhythmogenicity of the myocardial scar has not been documented by the existing data. Although there are still no randomized trials, percutaneous septal ablation is undeniably a viable alternative for patients with HOCM.
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Affiliation(s)
- Angelos G Rigopoulos
- 2nd Department of Cardiology, University of Athens Medical School, Athen, Greece
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