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Percutaneous transluminal septal myocardial ablation for hypertrophic obstructive cardiomyopathy through non-left anterior descending septal perforators

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Abstract

Percutaneous transluminal septal myocardial ablation (PTSMA) has become a significant treatment for symptomatic patients with hypertrophic obstructive cardiomyopathy (HOCM) despite maximal medical therapy. The target septal arteries usually arise from the left anterior descending artery (LAD). However, when septal perforators do not originate from the LAD, non-LAD septal perforators should be included as candidate-target septal branches that feed the hypertrophic septal myocardium, causing left ventricular outflow tract (LVOT) obstruction. Data pertaining to the procedure remain limited. We aimed to investigate PTSMA through the non-LAD septal perforators in patients with HOCM. In this case series review, we evaluated the baseline characteristics, echocardiographic features, and angiographic features, as well as symptoms and pressure gradient before and after PTSMA through the non-LAD septal perforators. Among 202 consecutive patients who underwent PTSMA for HOCM with LVOT obstruction, 21 had non-LAD septal branches that fed the hypertrophic septal myocardium and received alcohol ablation. Non-LAD septal perforators could be used as an alternative route for PTSMA in patients who experienced ineffective ablation of the septal branch that arises from the LAD. This unique procedure may improve response rates and overall outcomes of patients with HOCM.

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Authors and Affiliations

  1. Department of Cardiovascular Medicine, Nippon Medical School, Tokyo, 113-8603, Japan

    Yoichi Imori, Hitoshi Takano, Mitsunobu Kitamura, Rie Aoyama, Onodera Kenta, Junya Matsuda, Yoshiaki Kubota, Yukichi Tokita, Kuniya Asai, Morimasa Takayama & Wataru Shimizu

  2. Division of Cardiovascular Intensive Care, Nippon Medical School, Tokyo, Japan

    Hideto Sangen & Takeshi Yamamoto

  3. Department of Cardiology, Sakakibara Heart Institute, Tokyo, Japan

    Morimasa Takayama

Authors
  1. Yoichi Imori
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  2. Hitoshi Takano
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  3. Mitsunobu Kitamura
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  13. Wataru Shimizu
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Contributions

All the authors contributed to the study conception and design. Material preparation, data collection, and analysis were performed by YI and MK. The first draft of the manuscript was written by YI and all the authors commented on previous versions of the manuscript. All the authors read and approved the final manuscript.

Corresponding author

Correspondence to Hitoshi Takano.

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Conflict of interest

The authors declare that they have no conflict of interest.

Ethical approval

All procedures performed in these studies involving human participants were in accordance with the ethical standards of the institutional and national research committee (Nippon Medical School, approval no. 28-07-615) and with the 1964 Helsinki Declaration and its later amendments or comparable ethical standards. All patients who underwent PTSMA had been consecutively assigned to the institutional registry database at Nippon Medical School Hospital.

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Informed consent was obtained from all the individual participants included in the study.

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Imori, Y., Takano, H., Kitamura, M. et al. Percutaneous transluminal septal myocardial ablation for hypertrophic obstructive cardiomyopathy through non-left anterior descending septal perforators. Heart Vessels 35, 647–654 (2020). https://doi.org/10.1007/s00380-019-01525-8

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