From Baylor College of Medicine, Department of Medicine, Cardiology
Section, Houston, Tex.
Background—Left
ventricular outflow tract (LVOT) obstruction is frequently
responsible for symptoms in hypertrophic obstructive
cardiomyopathy (HOCM). Medical therapy is often not
sufficient to control these symptoms, and surgical myotomy-myomectomy
is required.
Methods and Results—We enrolled 33 symptomatic
patients with HOCM and obstruction (
Conclusions—Echocardiography-guided ethanol
septal reduction in patients with HOCM is a safe, minimally invasive
procedure that provides symptomatic relief with improved
hemodynamic and left ventricular
parameters.
© 1998 American Heart Association, Inc.
Clinical Investigation and Reports
Echocardiography-Guided Ethanol Septal Reduction for Hypertrophic Obstructive Cardiomyopathy
40 mm Hg gradient at rest
or 60 mm Hg dobutamine-provoked). By contrast
echocardiography, the bulging septum was localized
and infarcted by injection of 2 to 5 mL of absolute ethanol into the
septal artery(ies) supplying the hypertrophied area. Baseline
echocardiograms with Doppler, myocardial perfusion tomograms, and
treadmill exercise or pharmacological testing were compared with those
at 6 weeks and 6 months. The mean rise in creatine kinase was 1964±796
U. All patients experienced symptomatic relief; NYHA class
decreased from 3.0±0.5 to 0.9±0.6 (P<0.001). Exercise
time increased from 286±193 to 421±181 seconds
(P=0.03). The resting and
dobutamine-provoked gradient decreased from 49±33 and
96±34 mm Hg to 9±19 (P<0.001) and 24±31
mm Hg (P<0.001), respectively. Echocardiograms
repeated at 6 weeks after the procedure showed a 28% reduction in
septal thickness and 17% reduction in left ventricular
mass. Myocardial perfusion imaging showed a "septal amputation
pattern," with scarring in the upper and middle septal areas.
Complete heart block developed in 11 patients, who then required
permanent pacemaker implantation.
Key Words: hypertrophy • cardiomyopathy • ethanol • contrast media • echocardiography
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|
|
|
|
|
|
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|
|
|
|
|
|
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|
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|
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|
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|
|
|
|
|
|
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|
|
|
|
|
|
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|
|
|
|
|
|
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|
|
|
|
|
|
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|
|
|
|
|
|
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|
 |
|
 Ethanol Septal Reduction for HOCM Journal Watch Cardiology, November 13, 1998; 1998(1113): 5 - 5. [Full Text]
|
|
|
|
 |
|
 Echo-Guided Ethanol Injections for Hypertrophic Cardiomyopathy Journal Watch (General), November 3, 1998; 1998(1103): 6 - 6. [Full Text]
|
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|
|
|
|
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|
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