Percutaneous transluminal septal myocardial ablation (PTSMA) of hypertrophic cardiomyopathy: Indonesian initial experience
Aim Percutaneous transluminal septal myocardial ablation (PTSMA), a non-surgical intervention to treat hypertrophic cardiomyopathy (HCM), has been a standard treatment in developed countries. However, this procedure not yet systematically performed in Indonesia. This case series aim to study feasibility, safety and efficacy of PTSMA in National Cardiovascular Center Harapan Kita, Jakarta.
Methods Three HCM patients (2 male) with dynamic left ventricle outflow tract (LVOT) pressure gradient of higher than 30 mmHg underwent PTSMA. Left ventricle apex pressure was measured using multipurpose catheter and aortic pressure was measured by means of left coronary guiding catheter simultaneously. Target vessel is confirmed by myocardial echocardiography contrast. Two ml absolute alcohol delivered to the target vessel by means over the wire balloon. Immediate pressure gradient changed 10 minute after alcohol administration was recorded. Continuous ECG monitoring is attemted along the procedure.
Results All subject demonstrated more than 50% LVOT pressure gradient reduction. One subject experienced transient total AV block and right bundle branch block which completely recovered 6 hours after procedure. In one patient, target vessel must be changed as it gives perfusion to extensive area of right ventricle.
Conclusion PTSMA guided with myocardial echocardiography contrast is feasible, safe and effective to reduce LVOT pressure gradient in HCM patient. (Med J Indones 2009;19:164-71)
Seggewiss H. Percutaneous transluminal septal myocardial ablation: a new treatment for hypertrophic obstructive cardiomyopathy. Eur Heart J. 2000;21704-7.
Seggewiss H, Gleichmann U, Faber L, Fassbender D, Schmidt HK, Strick S. Percutaneous transluminal septal myocardial ablation in hypertrophic obstructive cardiomyopathy: acute results and 3-month follow-up in 25 patients. J Am Coll Cardiol. 1998;31:252-8.
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;83:326-31.
Maron BJ, Gardin JM, Flack JM, Gidding SS, Kurosaki TT, Bild DE. Prevalence of hypertrophic cardiomyopathy in a general population of young adults. Echocardiographic analysis of 4111 subjects in the CARDIA Study. Coronary Artery Risk Development in (Young) Adults. Circulation. 1995;92:785-9.
Maron BJ, Casey SA, Poliac LC, Gohman TE, Almquist AK, Aeppli DM. Clinical course of hypertrophic cardio-myopathy in a regional United States cohort. JAMA. 1999;281:650-5.
Niimura H, Patton KK, McKenna WJ, Soults J, Maron BJ, Seidman JG, Seidman CE. Sarcomere protein gene mutations in hypertrophic cardiomyopathy of the elderly. Circulation. 2002;105:446-51.
Maron BJ. The electrocardiogram as a diagnostic tool for hypertrophic cardiomyopathy: revisited. Ann Noninvasive Electrocardiol. 2001;6:277-9.
Maron BJ. Hypertrophic cardiomyopathy: a systematic review. JAMA. 2002;287:1308-20.
Klues HG, Schiffers A, Maron BJ. Phenotypic spectrum and patterns of left ventricular hypertrophy in hypertrophic cardiomyopathy: morphologic observations and significance as assessed by two-dimensional echocardiography in 600 patients. J Am Coll Cardiol. 1995;26:1699-708.
Spirito P, Bellone P, Harris KM, Bernabo P, Bruzzi P, Maron BJ. Magnitude of left ventricular hypertrophy and risk of sudden death in hypertrophic cardiomyopathy. N Engl J Med. 2000;342:1778-85.
Elliott PM, Gimeno Blanes JR, Mahon NG, Poloniecki JD, McKenna WJ. Relation between severity of left-ventricular hypertrophy and prognosis in patients with hypertrophic cardiomyopathy. Lancet. 2001;357:420-4.
Pelliccia A, Maron BJ, Spataro A, Proschan MA, Spirito P. The upper limit of physiologic cardiac hypertrophy in highly trained elite athletes. N Engl J Med. 1991;324:295-301.
Maron BJ, Pelliccia A, Spirito P. Cardiac disease in young trained athletes. Insights into methods for distinguishing athlete’s heart from structural heart disease, with particular emphasis on hypertrophic cardiomyopathy. Circulation. 1995;91:1596-601.
Faber L, Seggewiss H, Gleichmann U. Percutaneous transluminal septal myocardial ablation in hypertrophic obstructive cardiomyopathy: results with respect to intraprocedural myocardial contrast echocardiography. Circulation. 1998;98:2415-21.
Faber L, Ziemssen P, Seggewiss H. Targeting percutaneous transluminal septal ablation for hypertrophic obstructive cardiomyopathy by intraprocedural echocardiographic monitoring. J Am Soc Echocardiogr. 2000;13:1074-9.
Sorajja P, Valeti U, Nishimura RA, Ommen SR, Rihal CS, Gersh BJ, Hodge DO, Schaff HV, Holmes DR, Jr. Outcome of alcohol septal ablation for obstructive hypertrophic cardiomyopathy. Circulation. 2008;118:131-9.
Gietzen FH, Leuner CJ, Obergassel L, Strunk-Mueller C, Kuhn H. Role of transcoronary ablation of septal hypertrophy in patients with hypertrophic cardiomyopathy, New York Heart Association functional class III or IV, and outflow obstruction only under provocable conditions. Circulation. 2002;106:454-9.
Kuhn H, Lawrenz T, Lieder F, Leuner C, Strunk-Mueller C, Obergassel L, Bartelsmeier M, Stellbrink C. Survival after transcoronary ablation of septal hypertrophy in hypertrophic obstructive cardiomyopathy (TASH): a 10 year experience. Clin Res Cardiol. 2008;97:234-43.
Kazmierczak J, Kornacewicz-Jach Z, Kisly M, Gil R, Wojtarowicz A. Electrocardiographic changes after alcohol septal ablation in hypertrophic obstructive cardiomyopathy. Heart. 1998;80:257-62.
El-Jack SS, Nasif M, Blake JW, Dixon SR, Grines CL, O’Neill WW. Predictors of complete heart block after alcohol septal ablation for hypertrophic cardiomyopathy and the timing of pacemaker implantation. J Interv Cardiol. 2007;20:73-6.
Kern MJ, Holmes DG, Simpson C, Bitar SR, Rajjoub H. Delayed occurrence of complete heart block without warning after alcohol septal ablation for hypertrophic obstructive cardiomyopathy. Catheter Cardiovasc Interv. 2002;56:503-7.
Firoozi S, Elliott PM, Sharma S, Murday A, Brecker SJ, Hamid MS, Sachdev B, Thaman R, McKenna WJ. Septal myotomy-myectomy and transcoronary septal alcohol ablation in hypertrophic obstructive cardiomyopathy. A comparison of clinical, haemodynamic and exercise outcomes. Eur Heart J. 2002;23:1617-24.
Sitges M, Shiota T, Lever HM, Qin JX, Bauer F, Drinko JK, Agler DA, Martin MG, Greenberg NL, Smedira NG, Lytle BW, Tuzcu EM, Garcia MJ, Thomas JD. Comparison of left ventricular diastolic function in obstructive hypertrophic cardiomyopathy in patients undergoing percutaneous septal alcohol ablation versus surgical myotomy/myectomy. Am J Cardiol. 2003;91:817-21.
Gietzen FH, Leuner CJ, Obergassel L, Strunk-Mueller C, Kuhn H. Transcoronary ablation of septal hypertrophy for hypertrophic obstructive cardiomyopathy: feasibility, clinical benefit, and short term results in elderly patients. Heart. 2004;90:638-44.
Zeng Z, Wang F, Dou X, Zhang S, Pu J. Comparison of percutaneous transluminal septal myocardial ablation versus septal myectomy for the treatment of patients with hypertrophic obstructive cardiomyopathy--a meta analysis. Int J Cardiol. 2006;112:80-4
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