CLINICAL STUDY: HYPERTROPHIC CARDIOMYOPATHY
Outcome of patients with hypertrophic obstructive cardiomyopathy after percutaneous transluminal septal myocardial ablation and septal myectomy surgery1,2
Jian Xin, MDa,
Takahiro Shiota, MD, PhD, FACCa,
Harry M. Lever, MD, FACC*,a,
Samir R. Kapadia, MDa,
Marta Sitges, MDa,
David N. Rubin, MDa,
Fabrice Bauer, MDa,
Neil L. Greenberg, PhDa,
Deborah A. Agler, RDCSa,
Jeanne K. Drinko, RDCSa,
Maureen Martina,
Murat Tuzcu, MD, FACCa,
Nicholas G. Smedira, MD, FACCa,
Bruce Lytle, MD, FACCa and
James D. Thomas, MD, FACCa
a Cardiovascular Imaging Center, Department of Cardiology, The Cleveland Clinic Foundation, Cleveland, Ohio, USA
Manuscript received June 4, 2001;
revised manuscript received August 21, 2001,
accepted August 31, 2001.
* Reprint requests and correspondence: Dr. Harry M. Lever, Department of Cardiology-Desk F15, Cleveland Clinic Foundation, 9500 Euclid Avenue, Cleveland, Ohio 44195, USA.
leverh{at}ccf.org
OBJECTIVES: This study was conducted to evaluate follow-up results in patients with hypertrophic obstructive cardiomyopathy (HOCM) who underwent either percutaneous transluminal septal myocardial ablation (PTSMA) or septal myectomy.
BACKGROUND: Controversy exists with regard to these two forms of treatment for patients with HOCM.
METHODS: Of 51 patients with HOCM treated, 25 were treated by PTSMA and 26 patients via myectomy. Two-dimensional echocardiograms were performed before both procedures, immediately afterwards and at a three-month follow-up. The New York Heart Association (NYHA) functional class was obtained before the procedures and at follow-up.
RESULTS: Interventricular septal thickness was significantly reduced at follow-up in both groups (2.3 ± 0.4 cm vs. 1.9 ± 0.4 cm for septal ablation and 2.4 ± 0.6 cm vs. 1.7 ± 0.2 cm for myectomy, both p < 0.001). Estimated by continuous-wave Doppler, the resting pressure gradient (PG) across the left ventricular outflow tract (LVOT) significantly decreased immediately after the procedures in both groups (64 ± 39 mm Hg vs. 28 ± 29 mm Hg for PTSMA, 62 ± 43 mm Hg vs. 7 ± 7 mm Hg for myectomy, both p < 0.0001). At three-month follow-up, the resting PG remained lower in the PTSMA and myectomy groups (24 ± 19 mm Hg and 11 ± 6 mm Hg, respectively, vs. those before procedures, both p < 0.0001). The NYHA functional class was also significantly improved in both groups (3.5 ± 0.5 vs. 1.9 ± 0.7 for PTSMA, 3.3 ± 0.5 vs. 1.5 ± 0.7 for myectomy, both p < 0.0001).
CONCLUSIONS: Both myectomy and PTSMA reduce LVOT obstruction and significantly improve NYHA functional class in patients with HOCM. However, there are benefits and drawbacks for each therapeutic method that must be counterbalanced when deciding on treatment for LVOT obstruction.
|
Abbreviations and Acronyms
| | HOCM | | hypertrophic obstructive cardiomyopathy | | IVS | | interventricular septum | | LV | | left ventricle or left ventricular | | LVOT | | left ventricular outflow tract | | NYHA | | New York Heart Association | | PG | | pressure gradient | | PTSMA | | percutaneous transluminal septal myocardial ablation | | PW | | posterior wall | | SAM | | systolic anterior motion of mitral leaflet | | TEE | | transesophageal echocardiography |
|
This article has been cited by other articles:
|
|
|
|
 
M. Alam, H. Dokainish, and N. M. Lakkis
Hypertrophic obstructive cardiomyopathy-alcohol septal ablation vs. myectomy: a meta-analysis
Eur. Heart J.,
May 1, 2009;
30(9):
1080 - 1087.
[Abstract]
[Full Text]
[PDF]
|
|
|
|
|
|
|
P. Sorajja, R. A. Nishimura, S. R. Ommen, C. S. Rihal, B. J. Gersh, and D. R. Holmes Jr
Effect of Septal Ablation on Myocardial Relaxation and Left Atrial Pressure in Hypertrophic Cardiomyopathy: An Invasive Hemodynamic Study
J. Am. Coll. Cardiol. Intv.,
October 1, 2008;
1(5):
552 - 560.
[Abstract]
[Full Text]
[PDF]
|
|
|
|
|
|
|
V. L. Fernandes, C. Nielsen, S. F. Nagueh, A. E. Herrin, C. Slifka, J. Franklin, and W. H. Spencer III
Follow-Up of Alcohol Septal Ablation for Symptomatic Hypertrophic Obstructive Cardiomyopathy: The Baylor and Medical University of South Carolina Experience 1996 to 2007
J. Am. Coll. Cardiol. Intv.,
October 1, 2008;
1(5):
561 - 570.
[Abstract]
[Full Text]
[PDF]
|
|
|
|
|
|
|
S R Ommen, P M Shah, and A J Tajik
Left ventricular outflow tract obstruction in hypertrophic cardiomyopathy: past, present and future
Heart,
October 1, 2008;
94(10):
1276 - 1281.
[Full Text]
[PDF]
|
|
|
|
|
|
|
D. H. Kwon, S. R. Kapadia, E. M. Tuzcu, C. M. Halley, E. Z. Gorodeski, R. J. Curtin, M. Thamilarasan, N. G. Smedira, B. W. Lytle, H. M. Lever, et al.
Long-Term Outcomes in High-Risk Symptomatic Patients With Hypertrophic Cardiomyopathy Undergoing Alcohol Septal Ablation
J. Am. Coll. Cardiol. Intv.,
August 1, 2008;
1(4):
432 - 438.
[Abstract]
[Full Text]
[PDF]
|
|
|
|
|
|
|
U. Sigwart
Catheter Treatment for Hypertrophic Obstructive Cardiomyopathy: For Seniors Only?
Circulation,
July 8, 2008;
118(2):
107 - 108.
[Full Text]
[PDF]
|
|
|
|
|
|
|
P. Sorajja, U. Valeti, R. A. Nishimura, S. R. Ommen, C. S. Rihal, B. J. Gersh, D. O. Hodge, H. V. Schaff, and D. R. Holmes Jr
Outcome of Alcohol Septal Ablation for Obstructive Hypertrophic Cardiomyopathy
Circulation,
July 8, 2008;
118(2):
131 - 139.
[Abstract]
[Full Text]
[PDF]
|
|
|
|
|
|
|
M. A. Fifer and G. J. Vlahakes
Management of Symptoms in Hypertrophic Cardiomyopathy
Circulation,
January 22, 2008;
117(3):
429 - 439.
[Full Text]
[PDF]
|
|
|
|
|
|
|
A. W. ElBardissi, J. A. Dearani, R. A. Nishimura, S. R. Ommen, J. M. Stulak, and H. V. Schaff
Septal Myectomy After Previous Septal Artery Ablation in Hypertrophic Cardiomyopathy
Mayo Clin. Proc.,
December 1, 2007;
82(12):
1516 - 1522.
[Abstract]
[Full Text]
[PDF]
|
|
|
|
|
|
|
I. Olivotto, S. R. Ommen, M. S. Maron, F. Cecchi, and B. J. Maron
Surgical Myectomy Versus Alcohol Septal Ablation for Obstructive Hypertrophic Cardiomyopathy: Will There Ever Be a Randomized Trial?
J. Am. Coll. Cardiol.,
August 28, 2007;
50(9):
831 - 834.
[Abstract]
[Full Text]
[PDF]
|
|
|
|
|
|
|
S. F. Nagueh, J. M. Buergler, M. A. Quinones, W. H. Spencer III, and G. M. Lawrie
Outcome of Surgical Myectomy After Unsuccessful Alcohol Septal Ablation for the Treatment of Patients With Hypertrophic Obstructive Cardiomyopathy
J. Am. Coll. Cardiol.,
August 21, 2007;
50(8):
795 - 798.
[Abstract]
[Full Text]
[PDF]
|
|
|
|
|
|
|
B. J. Maron
Surgical Myectomy Remains the Primary Treatment Option for Severely Symptomatic Patients With Obstructive Hypertrophic Cardiomyopathy
Circulation,
July 10, 2007;
116(2):
196 - 206.
[Full Text]
[PDF]
|
|
|
|
|
|
|
M. A. Fifer
Most Fully Informed Patients Choose Septal Ablation Over Septal Myectomy
Circulation,
July 10, 2007;
116(2):
207 - 216.
[Full Text]
[PDF]
|
|
|
|
|
|
|
A. W. Heldman, K. C. Wu, T. P. Abraham, and D. E. Cameron
Myectomy or Alcohol Septal Ablation: Surgery and Percutaneous Intervention Go Another Round
J. Am. Coll. Cardiol.,
January 23, 2007;
49(3):
358 - 360.
[Full Text]
[PDF]
|
|
|
|
|
|
|
W. G. van Dockum, J. P.A. Kuijer, M. J.W. Gotte, F. J. ten Cate, J. M. ten Berg, A. M. Beek, J. W.R. Twisk, J. T. Marcus, C. A. Visser, and A. C. van Rossum
Septal ablation in hypertrophic obstructive cardiomyopathy improves systolic myocardial function in the lateral (free) wall: a follow-up study using CMR tissue tagging and 3D strain analysis
Eur. Heart J.,
December 1, 2006;
27(23):
2833 - 2839.
[Abstract]
[Full Text]
[PDF]
|
|
|
|
|
|
|
M. S. Maron, I. Olivotto, A. G. Zenovich, M. S. Link, N. G. Pandian, J. T. Kuvin, S. Nistri, F. Cecchi, J. E. Udelson, and B. J. Maron
Hypertrophic Cardiomyopathy Is Predominantly a Disease of Left Ventricular Outflow Tract Obstruction
Circulation,
November 21, 2006;
114(21):
2232 - 2239.
[Abstract]
[Full Text]
[PDF]
|
|
|
|
|
|
|
C. J Knight
Alcohol septal ablation for obstructive hypertrophic cardiomyopathy.
Heart,
September 1, 2006;
92(9):
1339 - 1344.
[Full Text]
[PDF]
|
|
|
|
|
|
|
P. M. Elliott, J. R. Gimeno, M. T. Tome, J. Shah, D. Ward, R. Thaman, J. Mogensen, and W. J. McKenna
Left ventricular outflow tract obstruction and sudden death risk in patients with hypertrophic cardiomyopathy
Eur. Heart J.,
August 2, 2006;
27(16):
1933 - 1941.
[Abstract]
[Full Text]
[PDF]
|
|
|
|
|
|
|
D. S. Jassal, T. G. Neilan, M. A. Fifer, I. F. Palacios, P. A. Lowry, G. J. Vlahakes, M. H. Picard, and D. M. Yoerger
Sustained improvement in left ventricular diastolic function after alcohol septal ablation for hypertrophic obstructive cardiomyopathy
Eur. Heart J.,
August 1, 2006;
27(15):
1805 - 1810.
[Abstract]
[Full Text]
[PDF]
|
|
|
|
|
|
|
S. R. Ommen, B. J. Maron, I. Olivotto, M. S. Maron, F. Cecchi, S. Betocchi, B. J. Gersh, M. J. Ackerman, R. B. McCully, J. A. Dearani, et al.
Long-Term Effects of Surgical Septal Myectomy on Survival in Patients With Obstructive Hypertrophic Cardiomyopathy
J. Am. Coll. Cardiol.,
August 2, 2005;
46(3):
470 - 476.
[Abstract]
[Full Text]
[PDF]
|
|
|
|
|
|
|
M. H. Yacoub
Surgical Versus Alcohol Septal Ablation for Hypertrophic Obstructive Cardiomyopathy: The Pendulum Swings
Circulation,
July 26, 2005;
112(4):
450 - 452.
[Full Text]
[PDF]
|
|
|
|
|
|
|
C. van der Lee, F. J. ten Cate, M. L. Geleijnse, M. J. Kofflard, C. Pedone, L. A. van Herwerden, E. Biagini, W. B. Vletter, and P. W. Serruys
Percutaneous Versus Surgical Treatment for Patients With Hypertrophic Obstructive Cardiomyopathy and Enlarged Anterior Mitral Valve Leaflets
Circulation,
July 26, 2005;
112(4):
482 - 488.
[Abstract]
[Full Text]
[PDF]
|
|
|
|
|
|
|
W. G. van Dockum, A. M. Beek, F. J. ten Cate, J. M. ten Berg, O. Bondarenko, M. J.W. Gotte, J. W.R. Twisk, M. B.M. Hofman, C. A. Visser, and A. C. van Rossum
Early Onset and Progression of Left Ventricular Remodeling After Alcohol Septal Ablation in Hypertrophic Obstructive Cardiomyopathy
Circulation,
May 17, 2005;
111(19):
2503 - 2508.
[Abstract]
[Full Text]
[PDF]
|
|
|
|
|
|
|
A. Woo, W. G. Williams, R. Choi, E. D. Wigle, E. Rozenblyum, K. Fedwick, S. Siu, A. Ralph-Edwards, and H. Rakowski
Clinical and Echocardiographic Determinants of Long-Term Survival After Surgical Myectomy in Obstructive Hypertrophic Cardiomyopathy
Circulation,
April 26, 2005;
111(16):
2033 - 2041.
[Abstract]
[Full Text]
[PDF]
|
|
|
|
|
|
|
A. Ralph-Edwards, A. Woo, B. W. McCrindle, J. L. Shapero, L. Schwartz, H. Rakowski, E. D. Wigle, and W. G. Williams
Hypertrophic obstructive cardiomyopathy: Comparison of outcomes after myectomy or alcohol ablation adjusted by propensity score
J. Thorac. Cardiovasc. Surg.,
February 1, 2005;
129(2):
351 - 358.
[Abstract]
[Full Text]
[PDF]
|
|
|
|
|
|
|
S C Agarwal, I F Purcell, and S S Furniss
Apical myocardial injury caused by collateralisation of a septal artery during ethanol septal ablation
Heart,
January 1, 2005;
91(1):
e2 - e2.
[Abstract]
[Full Text]
[PDF]
|
|
|
|
|
|
|
B. J. Maron, J. A. Dearani, S. R. Ommen, M. S. Maron, H. V. Schaff, B. J. Gersh, and R. A. Nishimura
The case for surgery in obstructive hypertrophic cardiomyopathy
J. Am. Coll. Cardiol.,
November 16, 2004;
44(10):
2044 - 2053.
[Abstract]
[Full Text]
[PDF]
|
|
|
|
|
|
|
C. D. Kimmelstiel and B. J. Maron
Role of Percutaneous Septal Ablation in Hypertrophic Obstructive Cardiomyopathy
Circulation,
February 3, 2004;
109(4):
452 - 456.
[Full Text]
[PDF]
|
|
|
|
|
|
|
W. G. van Dockum, F. J. ten Cate, J. M. ten Berg, A. M. Beek, J. W. R. Twisk, J. Vos, M. B. M. Hofman, C. A. Visser, and A. C. van Rossum
Myocardial infarction after percutaneous transluminal septal myocardial ablation in hypertrophic obstructive cardiomyopathy: evaluation by contrast-enhanced magnetic resonance imaging
J. Am. Coll. Cardiol.,
January 7, 2004;
43(1):
27 - 34.
[Abstract]
[Full Text]
[PDF]
|
|
|
|
|
|
|
A. Rovner, R. Smith, N. L. Greenberg, E. M. Tuzcu, N. Smedira, H. M. Lever, J. D. Thomas, and M. J. Garcia
Improvement in diastolic intraventricular pressure gradients in patients with HOCM after ethanol septal reduction
Am J Physiol Heart Circ Physiol,
December 1, 2003;
285(6):
H2492 - H2499.
[Abstract]
[Full Text]
[PDF]
|
|
|
|
|
|
|
B. J. Maron, W. J. McKenna, G. K. Danielson, L. J. Kappenberger, H. J. Kuhn, C. E. Seidman, P. M. Shah, W. H. Spencer III, P. Spirito, F. J. Ten Cate, et al.
American College of Cardiology/European Society of Cardiology Clinical Expert Consensus Document on Hypertrophic Cardiomyopathy: a report of the American College of Cardiology Foundation Task Force on Clinical Expert Consensus Documents and the European Society of Cardiology Committee for Practice Guidelines
J. Am. Coll. Cardiol.,
November 5, 2003;
42(9):
1687 - 1713.
[Full Text]
[PDF]
|
|
|
|
|
|
|
Writing Committee Members, B. J. Maron, W. J. McKenna, G. K. Danielson, L. J. Kappenberger, H. J. Kuhn, C. E. Seidman, P. M. Shah, W. H. Spencer III, P. Spirito, et al.
American College of Cardiology/European Society of Cardiology Clinical Expert Consensus Document on Hypertrophic Cardiomyopathy: A report of the American College of Cardiology Foundation Task Force on Clinical Expert Consensus Documents and the European Society of Cardiology Committee for Practice Guidelines
Eur. Heart J.,
November 1, 2003;
24(21):
1965 - 1991.
[Full Text]
[PDF]
|
|
|
|
|
|
|
M. V. Sherrid, F. A. Chaudhry, and D. G. Swistel
Obstructive hypertrophic cardiomyopathy: echocardiography, pathophysiology, and the continuing evolution of surgery for obstruction
Ann. Thorac. Surg.,
February 1, 2003;
75(2):
620 - 632.
[Abstract]
[Full Text]
[PDF]
|
|
|
|
|
|
|
M. S. Maron, I. Olivotto, S. Betocchi, S. A. Casey, J. R. Lesser, M. A. Losi, F. Cecchi, and B. J. Maron
Effect of Left Ventricular Outflow Tract Obstruction on Clinical Outcome in Hypertrophic Cardiomyopathy
N. Engl. J. Med.,
January 23, 2003;
348(4):
295 - 303.
[Abstract]
[Full Text]
[PDF]
|
|
|
|
|
|
|
S. Firoozi, P.M. Elliott, S. Sharma, A. Murday, S.J. Brecker, M.S. Hamid, B. Sachdev, R. Thaman, and W.J. McKenna
Septal myotomy-myectomy and transcoronary septal alcohol ablation in hypertrophic obstructive cardiomyopathy. A comparison of clinical, haemodynamic and exercise outcomes
Eur. Heart J.,
October 2, 2002;
23(20):
1617 - 1624.
[Abstract]
[Full Text]
[PDF]
|
|
|
|
|
|
|
E. Braunwald, C. E. Seidman, and U. Sigwart
Contemporary Evaluation and Management of Hypertrophic Cardiomyopathy
Circulation,
September 10, 2002;
106(11):
1312 - 1316.
[Full Text]
[PDF]
|
|
|
|
|
|
|
B. J. Maron
Hypertrophic Cardiomyopathy: A Systematic Review
JAMA,
March 13, 2002;
287(10):
1308 - 1320.
[Abstract]
[Full Text]
[PDF]
|
|
|
|
