Skip to main content
SpringerLink
Log in

Current status of alcohol septal ablation for patients with hypertrophic cardiomyopathy

  • Published:
Current Cardiology Reports Aims and scope Submit manuscript

Abstract

Since the early 1960s, surgical myotomy-myectomy has been the standard treatment for patients with drug-refractory symptoms due to hypertrophic cardiomyopathy and dynamic outflow tract obstruction. Comparable morphologic and functional results can be achieved by percutaneous septal ablation (PTSMA) by alcohol-induced septal branch occlusion. The circumscribed therapeutic myocardial infarction results in widening of the left ventricular outflow tract with consecutive gradient reduction. Follow-up studies show clinical and objective improvement as well as further gradient reduction due to left ventricular remodeling. In this article, an updated review of the latest results of PTSMA is provided.

This is a preview of subscription content, log in via an institution to check access.

Access this article

Log in via an institution

Price excludes VAT (USA)
Tax calculation will be finalised during checkout.

Instant access to the full article PDF.

Institutional subscriptions

Similar content being viewed by others

References and Recommended Reading

  1. Niimura H, Bachinski LL, Sangwatanaroj S, et al.: Mutations in the gene for cardiac myosin-binding protein C and late onset familial hypertrophic cardiomyopathy. N Engl J Med 1998, 338:1248–1257.

    Article  PubMed  CAS  Google Scholar 

  2. McKenna WJ, Coccolo F, Elliot PM: Genes and disease expression in hypertrophic cardiomyopathy. Lancet 1998, 352:1162–1163.

    Article  PubMed  CAS  Google Scholar 

  3. Wigle ED, Rakowski H, Kimball BP, et al.: Hypertrophic cardiomyopathy: Clinical spectrum and treatment. Circulation 1995, 92:1680–1692.

    PubMed  CAS  Google Scholar 

  4. Klues HG, Maron BJ, Dollar AL, et al.: Diversity of structural mitral valve alterations in hypertrophic cardiomyopathy. Circulation 1992, 85:1651–1660.

    PubMed  CAS  Google Scholar 

  5. Liberthson RR: Sudden death from cardiac causes in children and young adults. New Engl J Med 1996, 334:1039–1044.

    Article  PubMed  CAS  Google Scholar 

  6. Spirito P, Seidman CE, McKenna WJ, Maron BJ: The management of hypertrophic cardiomyopathy. N Engl J Med 1997, 336:775–785.

    Article  PubMed  CAS  Google Scholar 

  7. Maron BJ: Appraisal of dual-chamber pacing therapy in hypertrophic cardiomyopathy: too soon for a rush to judgment? J Am Coll Cardiol 1996, 27:431–432.

    Article  PubMed  CAS  Google Scholar 

  8. Schulte HD, Gramsch-Zabel H, Schwartzkopff B: Hypertrophe obstruktive Kardiomyopathie: Chirurgische Behandlung. Schweiz Med Wschr 1995, 125:1940–1949 (in German).

    PubMed  CAS  Google Scholar 

  9. Robbins RC, Stinson EB, Daily PO: Long-term results of left ventricular myotomy and myectomy for obstructive hypertrophic cardiomyopathy. J Thorac Cardiovasc Surg 1996, 111:586–594.

    Article  PubMed  CAS  Google Scholar 

  10. Heric B, Lytle BW, Miller DP, et al.: Surgical management of hypertrophic obstructive cardiomyopathy: early and late results. J Thorac Cardiovasc Surg 1995, 110:195–208.

    Article  PubMed  CAS  Google Scholar 

  11. Schoendube FA, Klues HG, Reith S, et al.: Long-term clinical and echocardiographic follow-up after surgical correction of hypertrophic obstructive cardiomyopathy with extended myectomy and reconstruction of the subvalvular mitral apparatus. Circulation 1995, 92(suppl II):122–127.

    Google Scholar 

  12. Maron BJ, Nishimura RA, Danielson GK: Pitfalls in clinical recognition and a novel operative approach for hypertrophic obstructive cardiomyopathy with severe obstruction due to anamalous papillary muscle. Circulation 1998, 98:2505–2508.

    PubMed  CAS  Google Scholar 

  13. Kuhn H, Gietzen F, Leuner C, et al.: Induction of subaortic ischaemia to reduce obstruction in hypertrophic obstructive cardiomyopathy. Eur Heart J 1997, 18:846–851.

    PubMed  CAS  Google Scholar 

  14. Sigwart U: Non-surgical myocardial reduction of hypertrophic obstructive cardiomyopathy. Lancet 1995, 346:211–214.

    Article  PubMed  CAS  Google Scholar 

  15. Seggewiss H, Gleichmann U, Faber L, et al.: Percutaneous transluminal septal myocardardial ablation (PTSMA) in hypertrophic obstructive cardiomyopathy: acute results and 3-month follow-up in 25 patients. J Am Coll Cardiol 1998, 31:252–258. Acute and short-term follow-up results of PTSMA pointed out the importance of necessary improvement of indentification of the target septal branch in order to optimize the amount of ablated septal area and reduce the rate of postinterventional trifascicular blocks with need of permanent pacemaker implantation.

    Article  PubMed  CAS  Google Scholar 

  16. Faber L, Seggewiss H, Gleichmann U: Percutaneous transluminal septal myocardial ablation in hypertrophic obstructive cardiomyopathy: Acute and 3-months follow-up results with respect to myocardial contrast echocardiography. Circulation 1998, 98:2415–2421. This report showed the influence of echocardiographic monitoring on acute and 3-month follow-up results after PTSMA with improvement of hemodynamic results as well as reduction of pacemaker implantation rate.

    PubMed  CAS  Google Scholar 

  17. Faber L, Seggewiss H, Fassbender D, et al.: Guiding of percutaneous transluminal septal myocardial ablation in hypertrophic obstructive cardiomyopathy by myocardial contrast echocardiography. J Interv Cardiol 1998, 11:443–448.

    Google Scholar 

  18. Faber L, Seggewiss H, Ziemssen P, Gleichmann U: Intraprocedural myocardial contrast echocardiography as a routine procedure in percutaneous transluminal septal myocardial ablation: detection of threatening myocardial necrosis distant from the septal target area. Catheter Cardiovasc Interv 1999, 47:462–466.

    Article  PubMed  CAS  Google Scholar 

  19. Ruzyllo W, Chojnowska L, Demkow M, et al.: Left ventricular outflow tract gradient decrease with non-surgical myocardial reduction improves exercise capacity in patients with hypertrophic obstructive cardiomyopathy. Eur Heart J 2000, 21:770–777. The report underlines the importance of achieving a greater than 50% gradient reduction to obtain a sufficient clinical result. Furthermore, it gives an important technical hint to avoid alcohol leakage.

    Article  PubMed  CAS  Google Scholar 

  20. Maron BJ, Casey SA, Poliac LC, et al.: Clinical course of hypertrophic cardiomyopathy in a regional United States cohort. JAMA 1999, 281:650–655.

    Article  PubMed  CAS  Google Scholar 

  21. Seggewiss H, Faber L, Meyners W, et al.: Simultaneous percutaneous treatment in hypertrophic obstructive cardiomyopathy and coronary artery disease: a case report. Cathet Cardiovasc Diagn 1998, 44:65–69.

    Article  PubMed  CAS  Google Scholar 

  22. Gleichmann U, Seggewiss H, Faber L, et al.: Kathetertherapie der hypertrophen obstruktiven Kardiomyopathie. Dtsch Med Wschr 1996, 21:679–685 (in German).

    Article  Google Scholar 

  23. Gietzen FH, Leuner CJ, Raute-Kreinsen U, et al.: Acute and long-term results after transcoronary ablation of septal hypertrophy (TASH). Catheter interventional treatment for hypertrophic obstructive cardiomyopathy. Eur Heart J 1999, 20:1342–1354. Results of percutaneous septal myocardial reduction with a high incidence of permanent trifascicular block as well as re-interventions.

    Article  PubMed  CAS  Google Scholar 

  24. Seggewiss H, Faber L, Strick S, et al.: Ongoing clinical and non-invasive improvement after percutaneous transluminal septal myocardial ablation (PTSMA) in hypertrophic obstructive cardiomyopathy (HOCM) [abstract]. Circulation 1998, 98(suppl I):506.

    Google Scholar 

  25. Knight C, Kurbaan AS, Seggewiss H, et al.: Non-surgical septal reduction for hypertrophic obstructive cardiomyopathy: outcome in the first series of patients. Circulation 1997, 95:2075–2081.

    PubMed  CAS  Google Scholar 

  26. Lakkis N, Kleiman N, Killip D, et al.: Hypertrophic obstructive cardiomyopathy: alternative therapeutic options. Clin Cardiol 1997, 20:417–418.

    PubMed  CAS  Google Scholar 

  27. Bhargava B, Agarval R, Kaul U, et al.: Transcatheter alcohol ablation of the septum in a patient of hypertrophic obstructive cradiomyopathy. Cathet Cardiovasc Diagn 1997, 41:56–58.

    Article  PubMed  CAS  Google Scholar 

  28. Kornacewicz-Jach Z, Gil R, Wojtarowicz A, et al.: Early results of alcohol ablation of the septal branch of coronary artery in patients with hypertrophic obstructive cardiomyopathy [Polish]. Kardiol Pol 1998, 48:105–112.

    Google Scholar 

  29. Nagueh SF, Lakkis NM, He Z-X, et al.: Role of myocardial contrast echocardiography during nonsurgical reduction therapy for hypertrophic obstructive cardiomyopathy. J Am Coll Cardiol 1998, 32:225–229. Alcohol-induced occlusion of several septal branches resulted in high increase if peak creatine kinase (up to 4230 U/L) and a perfusion defect size involving a mean of 9.5% of the left ventricular myocardium. This resulted in a high incidence of permanent pacemakers after the procedure.

    Article  PubMed  CAS  Google Scholar 

  30. Seggewiss H, Faber L, Ziemssen P, et al.: Age related acute results in percutaneous septal ablation in hypertrophic obstructive cardiomyopathy [abstract]. J Am Coll Cardiol 2000, 35(suppl A):188A.

    Google Scholar 

  31. Seggewiss H, Faber L, Ziemssen P, Meyners W: Non-surgical septal ablation (PTSMA) in patients with NYHA class IV and hypertrophic obstructive cardiomyopathy (HOCM) [abstract]. Circulation 1999, 100(suppl I):515.

    Google Scholar 

  32. Kuhn H, Gietzen F, Leuner CH, et al.: Transcoronary ablation of septal hypertrophy: a new treatment for hypertrophic obstructive cardiomyopathy. Z Kardiol 2000, 89(suppl 4):41–54.

    Google Scholar 

  33. Seggewiss H, Faber L: Percutaneous septal ablation for hypertrophic cardiomyopathy and mid-ventricular obstruction. Eur J Echocardiogr 2001, in press.

  34. Kurbaan AS, Seggewiss H, Henein MY, et al.: Non-surgical septal reduction for hypertrophic obstructive cardiomyopathy: long-term follow-up of the early patients [abstract]. Circulation 1997, 96(suppl):463.

    Google Scholar 

  35. Seggewiss H, Faber L, Gleichmann U: Percutaneous transluminal septal ablation in hypertrophic obstructive cardiomyopathy. Thorac Cardiovasc Surg. 1999, 47:94–100.

    PubMed  CAS  Google Scholar 

  36. Faber L, Meissner A, Ziemssen P, Seggewiss H: Percutaneous transluminal septal myocardial ablation for hypertrophic obstructive cardiomyopathy: long term follow up of the first series of 25 patients. Heart 2000, 83:326–331.

    Article  PubMed  CAS  Google Scholar 

  37. Ziemssen P, Faber L, Schlichting J, et al.: Percutaneous septal ablation in patients with hypertrophic obstructive cardiomyopathy results in improvement of exercise capacity [abstract]. J Am Coll Cardiol 2000, 35:182A.

    Google Scholar 

  38. Curtius JM, Stoecker J, Loesse B, et al.: Changes of the degree of hypertrophy in hypertrophic obstructive cardiomyopathy under medical and surgical treatment. Cardiology 1989, 76:255–263.

    Article  PubMed  CAS  Google Scholar 

Download references

Author information

Authors and Affiliations

  1. Medizinische Klinik I, Leopoldina-Krankenhaus, Gustav-Adolf-Strasse 8, 97422, Schweinfurt, Germany

    Hubert Seggewiss MD

Authors
  1. Hubert Seggewiss MD
    View author publications

    You can also search for this author in PubMed Google Scholar

Rights and permissions

Reprints and permissions

About this article

Cite this article

Seggewiss, H. Current status of alcohol septal ablation for patients with hypertrophic cardiomyopathy. Curr Cardiol Rep 3, 160–166 (2001). https://doi.org/10.1007/s11886-001-0044-7

Download citation

  • Issue Date:

  • DOI: https://doi.org/10.1007/s11886-001-0044-7

Keywords

Search

Navigation