Hypertrophic cardiomyopathy: invasive management of left ventricular outflow tract obstruction

ESC CardioMed ◽  
2018 ◽  
pp. 1459-1462
Author(s):  
Steve R. Ommen
Keyword(s):  
Hypertrophic Cardiomyopathy ◽  
Left Ventricular Outflow Tract ◽  
Ventricular Outflow Tract ◽  
Left Ventricular ◽  
Outflow Tract ◽  
Success Rates ◽  
Alcohol Septal Ablation ◽  
Septal Myectomy ◽  
Ventricular Outflow Tract Obstruction ◽  
Left Ventricular Outflow

Left ventricular outflow tract obstruction in hypertrophic cardiomyopathy can result in considerable symptoms. While pharmacological therapies are the first-line treatment for most patients, there are invasive therapies that have shown excellent success in relieving these drug-refractory symptoms. Surgical septal myectomy and percutaneous alcohol septal ablation, each with relative merits and risks, offer high success rates when performed in the context of specialized hypertrophic cardiomyopathy programmes.

scholarly journals Contrast Enhanced Echocardiography-Controlled Alcohol Septal Ablation for Hypertrophic Cardiomyopathy with Left Ventricular Outflow Tract Obstruction

2019 ◽  
Vol 9 (2) ◽  
pp. 132-137
Author(s):  
I. E. Nikolaeva ◽  
V. V. Plechev ◽  
A. M. Mukhametyanov ◽  
R. M. Biktashev ◽  
I. V. Buzaev ◽  
...  
Keyword(s):  
Hypertrophic Cardiomyopathy ◽  
Left Ventricular Outflow Tract ◽  
Ventricular Outflow Tract ◽  
Left Ventricular ◽  
Outflow Tract ◽  
Alcohol Septal Ablation ◽  
Ventricular Outflow Tract Obstruction ◽  
Contrast Enhanced ◽  
Contrast Enhanced Echocardiography ◽  
Left Ventricular Outflow

In the SFHI (State Funded Healthcare Institution) Republic’s Centre for Cardiology the method of alcohol septal ablation has been introduced in 2015. The paper presents one case of a successful treatment of a patient with hypertrophic cardiomyopathy with left ventricular outflow tract obstruction treated with the use of the method of alcohol septal ablation under control of contrast enhanced echocardiography of the ablation area in the interventricular septum.

scholarly journals Haemodynamic Interplay Between Concomitant Left Ventricular Outflow Tract Obstruction and Aortic Stenosis

2021 ◽  
Vol 16 ◽  
Author(s):  
Priya Bansal ◽  
Hamza Lodhi ◽  
Adithya Mathews ◽  
Anand Desai ◽  
Ramez Morcos ◽  
...  
Keyword(s):  
Hypertrophic Cardiomyopathy ◽  
Aortic Stenosis ◽  
Left Ventricular Outflow Tract ◽  
Ventricular Outflow Tract ◽  
Left Ventricular ◽  
Outflow Tract ◽  
Alcohol Septal Ablation ◽  
Ventricular Outflow Tract Obstruction ◽  
Left Ventricular Outflow

The authors describe a patient with hypertrophic cardiomyopathy with concomitant left ventricular outflow tract obstruction and aortic stenosis. Detailed haemodynamic assessment of the serial lesions was performed. Alcohol septal ablation resulted in a significant reduction of gradients across the left ventricular outflow tract.

Secondary chordal resection with septal myectomy for treatment of symptomatic obstructive hypertrophic cardiomyopathy

2021 ◽  
Author(s):  
Eilon Ram ◽  
Ehud Schwammenthal ◽  
Rafael Kuperstein ◽  
Tamer Jamal ◽  
Eyal Nahum ◽  
...  
Keyword(s):  
Heart Failure ◽  
Hypertrophic Cardiomyopathy ◽  
Left Ventricular Outflow Tract ◽  
Ventricular Outflow Tract ◽  
Left Ventricular ◽  
Outflow Tract ◽  
Interquartile Range ◽  
Septal Myectomy ◽  
Ventricular Outflow Tract Obstruction ◽  
Left Ventricular Outflow

Abstract OBJECTIVES Left ventricular outflow tract obstruction causes symptoms of heart failure in most patients with hypertrophic cardiomyopathy. Resection of the secondary mitral valve (MV) chordae has recently been shown to move the MV apparatus posteriorly, thereby eradicating the outflow gradient. The aim of this study was to evaluate whether secondary chordal resection concomitant to septal myectomy improves outcomes. METHODS Between 2005 and 2020, a total of 165 patients underwent septal myectomy without MV repair or replacement in our Medical Center. Secondary MV chordal resection was performed in 60 patients, and their outcomes were compared with those of the remaining 105 patients who did not undergo chordal resection (controls). Mean age was 61 ± 13 and 58 ± 16 years, respectively (P = 0.205). RESULTS There were no in-hospital deaths throughout the entire cohort. Of those patients who underwent secondary chordal resection, New York Heart Association functional class decreased from 3 (interquartile range 2–3) preoperatively to 1 (interquartile range 1–2) postoperatively (P < 0.001), and resting outflow gradient decreased from 91 ± 39 mmHg to 13 ± 8 mmHg (86% change, P < 0.001). Compared with controls, patients who underwent secondary chordal resection had a significant lower resting outflow gradient at follow-up (14 ± 7 mmHg vs 21 ± 15 mmHg, P = 0.002). The rate of moderate or more than moderate mitral regurgitation at 5 years was 2% in the secondary chordal resection group and 5% in the controls (hazard ratio 1.05, confidence interval 0.11–10.32; P = 0.965). CONCLUSIONS In this observational study, we report that secondary chordal resection concomitant to septal myectomy for left ventricular outflow tract obstruction is safe, relieves heart failure symptoms and reduces left ventricular outflow tract gradient in appropriately selected patients.

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