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Dai Z, Iguchi N, Takamisawa I, Takayama M, Nanasato M, Kanisawa M, Mizuno N, Miyazaki S, Isobe M. Alcohol septal ablation markedly reduces energy loss in hypertrophic cardiomyopathy with left ventricular outflow tract obstruction: A four-dimensional flow cardiac magnetic resonance study. Int J Cardiol Heart Vasc 2021; 37:100886. [PMID: 34692989 PMCID: PMC8515238 DOI: 10.1016/j.ijcha.2021.100886] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/09/2021] [Revised: 09/23/2021] [Accepted: 09/26/2021] [Indexed: 11/16/2022]
Abstract
Background Functional follow-up modalities of hypertrophic cardiomyopathy (HCM) with left ventricular (LV) outflow tract obstruction (LVOTO) subjected to alcohol septal ablation (ASA) are limited. Methods This retrospective cohort study included patients of HCM with LVOTO who underwent ASA and four-dimensional (4D) flow cardiac magnetic resonance imaging (MRI) both before and after ASA. We analyzed energy loss in one cardiac cycle within the three-chamber plane of the LV and aortic root, and compared between pre- and post-ASA measurements. Results Of the 26 included patients, 10 (39%) were male, and median age was 71 (interquartile range 58–78) years. ASA significantly reduced not only LVOT pressure gradient (70 [19–50] to 9 [3–16], P < 0.001), but also energy loss during one cardiac cycle within the three-chamber plane of the LV and aortic root (80 [65–99] to 56 [45–70], P < 0.001). A linear association was observed between the reductions of energy loss and pressure gradient (R2 = 0.58, P < 0.001). Conclusions ASA significantly reduced energy loss within the LV and aortic root as quantified by 4D flow MRI, reflecting the decreased cardiac workload. This approach is a promising candidate for serial functional follow-up in patients undergoing ASA.
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Key Words
- 4D flow MRI
- 4D, four-dimensional
- ASA, alcohol septal ablation
- Alcohol septal ablation
- Energy loss
- HCM, hypertrophic cardiomyopathy
- Hypertrophic cardiomyopathy
- LV, left ventricle/left ventricular
- LVOT, left ventricular outflow tract
- LVOTO, left ventricular outflow tract obstruction
- Left ventricular outflow tract obstruction
- MRI, magnetic resonance imaging
- NYHA, New York Heart Association
- ROI, region of interest
- TTE, transthoracic echocardiography
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Affiliation(s)
- Zhehao Dai
- Department of Cardiology, Sakakibara Heart Institute, 3-16-1 Asahi-cho, Fuchu, Tokyo 183-0003, Japan.,Department of Cardiovascular Medicine, The University of Tokyo Graduate School of Medicine, 7-3-1 Hongo, Bunkyo-ku, Tokyo 113-8655, Japan
| | - Nobuo Iguchi
- Department of Cardiology, Sakakibara Heart Institute, 3-16-1 Asahi-cho, Fuchu, Tokyo 183-0003, Japan.,Department of Radiology, Sakakibara Heart Institute, 3-16-1 Asahi-cho, Fuchu, Tokyo 183-0003, Japan
| | - Itaru Takamisawa
- Department of Cardiology, Sakakibara Heart Institute, 3-16-1 Asahi-cho, Fuchu, Tokyo 183-0003, Japan
| | - Morimasa Takayama
- Department of Cardiology, Sakakibara Heart Institute, 3-16-1 Asahi-cho, Fuchu, Tokyo 183-0003, Japan
| | - Mamoru Nanasato
- Department of Cardiology, Sakakibara Heart Institute, 3-16-1 Asahi-cho, Fuchu, Tokyo 183-0003, Japan
| | - Mitsuru Kanisawa
- Department of Radiology, Sakakibara Heart Institute, 3-16-1 Asahi-cho, Fuchu, Tokyo 183-0003, Japan
| | - Naokazu Mizuno
- Department of Radiology, Sakakibara Heart Institute, 3-16-1 Asahi-cho, Fuchu, Tokyo 183-0003, Japan
| | - Shohei Miyazaki
- Cardio Flow Design Inc., 22-3 Ichibancho, Chiyoda-ku, Tokyo 102-0082, Japan
| | - Mitsuaki Isobe
- Sakakibara Heart Institute, 3-16-1 Asahi-cho, Fuchu, Tokyo 183-0003, Japan
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Qintar M, Villablanca P, Lee J, Wang DD, Frisoli T, O’Neill B, Eng MH, O’Neill WW. Emergency Alcohol Septal Ablation for Shock After TAVR: One More Option in the Toolbox. JACC Case Rep 2021; 3:853-858. [PMID: 34317641 PMCID: PMC8311368 DOI: 10.1016/j.jaccas.2021.03.028] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/20/2021] [Revised: 03/08/2021] [Accepted: 03/24/2021] [Indexed: 11/18/2022]
Abstract
We hereby report a case of severe shock from left ventricular outflow tract obstruction following transcatheter aortic valve replacement that did not respond to medical therapy and had to be treated with emergent alcohol septal ablation (ASA). Emergent ASA should be considered for bail-out treatment for these refractory cases. (Level of Difficulty: Advanced.)
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Affiliation(s)
- Mohammed Qintar
- Address for correspondence: Dr. Mohammed Qintar, Henry Ford Hospital, Center for Structural Heart Disease, 2799 West Grand Boulevard, Clara Ford Pavilion, 4th Floor, Detroit, Michigan 48202, USA.
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Engel Gonzalez P, Turer AT, Doolabh N, Jessen ME, Kumbhani DJ. Preemptive Alcohol Septal Ablation Prior to Valve-in-Valve Transcatheter Mitral Valve Replacement With Bioprosthetic Balloon Fracture. JACC Case Rep 2021; 3:366-369. [PMID: 34317538 PMCID: PMC8311042 DOI: 10.1016/j.jaccas.2020.12.021] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/10/2020] [Revised: 12/18/2020] [Accepted: 12/24/2020] [Indexed: 11/18/2022]
Abstract
A 78-year-old woman with bioprosthetic mitral valve degeneration at high risk for reoperation was referred for transcatheter mitral valve replacement. We describe the use of a preemptive alcohol septal ablation pre-procedurally to minimize the risk of acute left ventricular outflow tract obstruction given the anticipated need for a bioprosthetic valve fracture. (Level of Difficulty: Advanced.)
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Affiliation(s)
- Pedro Engel Gonzalez
- Division of Cardiology, Department of Internal Medicine, University of Texas Southwestern Medical Center, Dallas, Texas, USA
| | - Aslan T. Turer
- Division of Cardiology, Department of Internal Medicine, University of Texas Southwestern Medical Center, Dallas, Texas, USA
| | - Neelan Doolabh
- Department of Cardiovascular and Thoracic Surgery, University of Texas Southwestern Medical Center, Dallas, Texas, USA
| | - Michael E. Jessen
- Department of Cardiovascular and Thoracic Surgery, University of Texas Southwestern Medical Center, Dallas, Texas, USA
| | - Dharam J. Kumbhani
- Division of Cardiology, Department of Internal Medicine, University of Texas Southwestern Medical Center, Dallas, Texas, USA
- Address for correspondence: Dr. Dharam J. Kumbhani, UT Southwestern Medical Center, 2001 Inwood Road, Suite WC05.852, Dallas, Texas 75390-9254, USA.
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Peigh G, Wasserlauf J, Choudhury L, Knight BP, Kim S. From 100 to 0: Endocardial Radiofrequency Ablation of Septal Hypertrophy for Management of Hypertrophic Cardiomyopathy. JACC Case Rep 2020; 2:1173-1177. [PMID: 34317442 PMCID: PMC8311700 DOI: 10.1016/j.jaccas.2020.05.042] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/18/2020] [Revised: 04/23/2020] [Accepted: 05/06/2020] [Indexed: 06/13/2023]
Abstract
Septal reduction techniques can reduce morbidity and mortality in patients with hypertrophic cardiomyopathy. In a patient with hypertrophic cardiomyopathy who was a poor candidate for surgical myectomy and alcohol septal ablation, endocardial radiofrequency ablation of septal hypertrophy provided durable reduction in left ventricular outflow tract gradients and symptomatic improvement. (Level of Difficulty: Intermediate.).
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Affiliation(s)
| | | | | | | | - Susan Kim
- Address for correspondence: Dr. Susan Kim, Division of Cardiology, Northwestern Memorial Hospital, 251 E. Huron Street, Room 8-340, Chicago, Illinois 60611.
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