Nonsurgical Septal Reduction for Hypertrophic Obstructive Cardiomyopathy

Outcome in the First Series of Patients

Knight, Charles MA, MRCP
Kurbaan, Arvinder S. MB, MRCP
Seggewiss, Hubert MD
Henein, Michael MD
Gunning, Mark MB, MRCP
Harrington, Derek MB, MRCP
Fassbender, Dieter MD
Gleichmann, Ulrich MD
Sigwart, Ulrich MD, FRCP, FESC

Received August 20, 1996; revision received November 4, 1996; accepted November 23, 1996.
From the Royal Brompton Hospital (C.K., A.S.K., M.H., M.G., D.H., U.S.), London, England, and the Heart and Diabetes Centre (H.S., D.F., U.G.), Nordrhein-Westfalen, Universitatsklinik der Ruhr-Universitat Bochum, Bad Oeynhausen, Germany.
Reprint requests to Ulrich Sigwart, MD, Department of Invasive Cardiology, Royal Brompton Hospital, Sydney Street, London SW3 6NP UK.

Circulation 95(8):p 2075-2081, April 15, 1997.

Background

Some patients with hypertrophic obstructive cardiomyopathy may gain symptomatic relief from a reduction in the extent of obstruction to left ventricular outflow. We present the outcome of the first series of patients treated with an alternative method of gradient reduction using catheter techniques.

Methods and Results

Eighteen patients were treated with selective intracoronary alcohol injection to induce localized septal infarction. Patients underwent echocardiographic measurement of left ventricular dimensions and Doppler echocardiographic evaluation of left ventricular outflow tract gradients before the procedure, on the first postoperative day, and at a median follow-up of 3 months after the procedure. In addition, patients underwent exercise testing and symptom evaluation before and 3 months after nonsurgical septal reduction. There was a significant reduction in left ventricular outflow tract obstruction after the procedure (preprocedure, 67 mm Hg [95% CI, 48 to 87 mm Hg]; postprocedure, 25 mm Hg [95% CI, 16 to 34 mm Hg]; P = .0006), which persisted at 3-month follow-up (22 mm Hg [95% CI, 12 to 32 mm Hg]; P = .001). This was associated with a significant improvement in symptoms. There was a small but not significant increase in exercise capacity (n = 10; preprocedure, 418 seconds [95% CI, 273 to 563 seconds]; postprocedure, 452 seconds [95% CI, 283 to 621 seconds). Left ventricular dimensions were not significantly altered by nonsurgical septal reduction.

Conclusions

Nonsurgical septal reduction significantly reduces left ventricular outflow tract obstruction and improves symptoms in some patients with hypertrophic obstructive cardiomyopathy. The technique may provide an alternative to surgical myomectomy in selected patients. (Circulation. 1997;95:2075-2081.)