Catheter treatment of hypertrophic obstructive cardiomyopathy
Ulrich Sigwart, Rod Stables
Department of Interventional Cardiology, Royal Brompton & Harefield NHS Trust, London, United Kingdom
Ulrich Sigwart Royal Brompton & Harefield NHS Trust, Sydney Street, London SW3 6NP United Kingdom
Source of Support: None, Conflict of Interest: None
Non-surgical septal reduction (NSSR) is a promising new therapy for the treatment of classical hypertrophic obstructive cardiomyopathy (HOCM). Patients should have symptoms related to a significant left ventricular outflow tract gradient. The procedure involves the selective injection of absolute alcohol into the hypertrophied basal septum via the epicardial coronary vessels. This results in localized infarction with septal thinning and the other changes that tend to reduce the LVOT gradient. The procedure is well tolerated with low mortality. The principal complication is the development of heart block, which demands pacemaker implantation in around 20% of patients.
Hemodynamic and functional improvement may take some time to become evident and improvement may continue for several months after the procedure. Emerging medium-term follow-up data suggest that the benefits are sustained with no late morbidity. The long-term outcome of the procedure is not known and its value has never been compared to other therapeutic options in randomized controlled trials.