NONSURGICAL SEPTAL REDUCTION FOR HYPERTROPHIC OBSTRUCTIVE CARDIOMYOPATHY - OUTCOME IN THE FIRST SERIES OF PATIENTS

Background Some patients with hypertrophic obstructive cardiomyopathy may gain symptomatic relief from a reduction in the extent of obstruct ion to left ventricular outflow. We present the outcome of the first s eries of patients treated with an alternative method of gradient reduc tion using catheter techniques. Methods and Results Eighteen patients were treated with selective intracoronary alcohol injection to induce localized septal infarction. Patients underwent echocardiographic meas urement of left ventricular dimensions and Doppler echocardiographic e valuation of left ventricular outflow tract gradients before the proce dure, on the first postoperative day, and at a median follow-up of 3 m onths after the procedure. In addition, patients underwent exercise te sting and symptom evaluation before and 3 months after nonsurgical sep tal reduction. There was a significant reduction in left ventricular o utflow tract obstruction after the procedure (preprocedure, 67 mmHg [9 5% CI, 48 to 57 mm Hg]; postprocedure, 25 mm Hg [95% CI, 16 to 34 mmHg ]; P=.0006), which persisted at 3-month follow-up (22 mm Hg [95% CI, 1 2 to 32 mm Hg]; P=.001). This was associated with a significant improv ement in symptoms. There was a small but not significant increase in e xercise capacity (n=10; preprocedure, 418 seconds [95% CI, 273 to 563 seconds]; postprocedure, 452 seconds [95% CI, 283 to 621 seconds). Lef t ventricular dimensions were not significantly altered by nonsurgical septal reduction. Conclusions Nonsurgical septal reduction significan tly reduces left ventricular outflow tract obstruction and improves sy mptoms in some patients with hypertrophic obstructive cardiomyopathy. The technique may provide an alternative to myomectomy in selected pat ients.