Vol 59, No 10 (2003)
Other
Published online: 2005-12-12
Submitted: 2012-12-28
Get Citation

Early and long-term results of non-surgical septal reduction in patients with hypertrophic cardiomyopathy

Lidia Chojnowska, Witold Rużyłło, Adam Witkowski, Beata Kuśmierczyk-Droszcz, Cezary Kępka, Marek Konka, Longina Małecka, Maciej Karcz, Janina Stępińska
Kardiol Pol 2003;59(10):276-281.
Vol 59, No 10 (2003)
Other
Published online: 2005-12-12
Submitted: 2012-12-28

Abstract

Background: Non-surgical septal reduction (NSMR) is a new method of treatment in patients with hypertrophic obstructive cardiomyopathy (HOCM). The long-term outcome of patients undergoing this procedure has not yet been well established.
Aim: To assess the short- and long-term results of NSMR in HOCM.
Methods: Early and late (3-year) outcome after NSMR was assessed in 59 and 44 consecutive patients with HOCM, respectively. Control out-patient visits were scheduled 3, 6, and 12 months after NSMR, and annually thereafter. All patients had repeated ECG, echocardiography, 24-hour ambulatory ECG monitoring and spiro-ergometric tests.
Results: Left ventricular outflow tract (LVOT) gradient, measured invasively directly after the procedure, decreased from 79.5±29.6 to 26.2±18.5 mmHg (p<0.0001). A significant LVOT gradient reduction was achieved in 51 (86%) patients. A complete a-v block occurred in 17 (29%) patients, of whom 7 (12%) underwent dual-chamber pacemaker implantation. A significant decrease in exertional dyspnea and angina was observed three months after NSMR (NYHA class reduction from 2.9±0.2 to 1.4±0.7, p=0.001 and CCS class reduction from 2.3±0.3 to 0.5±0.7, p=0.001, respectively). Of the 45 patients who were followed for ≥3 years, one patient died due to lung disease whereas no sudden deaths or life-threatening ventricular arrhythmias were observed. LVOT gradient was further reduced, and three years after NMSR disappeared in 35 (59%) patients. A significant improvement in physical capacity was noted (peakVO2 increased from 14.1±3.8 ml/kg/min before NSMR to 23.2±6.2 three years later, p=0.02). Favourable LV remodelling was observed, causing LVOT dilatation and an increase in LV diastolic volume.
Conclusions: Because NSMR causes a significant reduction of LVOT gradient, an increase in physical capacity in >80% of patients and the long-term follow-up is uneventful, it may be regarded as an alternative procedure to myectomy in the treatment of patients with HOCM.

Abstract

Background: Non-surgical septal reduction (NSMR) is a new method of treatment in patients with hypertrophic obstructive cardiomyopathy (HOCM). The long-term outcome of patients undergoing this procedure has not yet been well established.
Aim: To assess the short- and long-term results of NSMR in HOCM.
Methods: Early and late (3-year) outcome after NSMR was assessed in 59 and 44 consecutive patients with HOCM, respectively. Control out-patient visits were scheduled 3, 6, and 12 months after NSMR, and annually thereafter. All patients had repeated ECG, echocardiography, 24-hour ambulatory ECG monitoring and spiro-ergometric tests.
Results: Left ventricular outflow tract (LVOT) gradient, measured invasively directly after the procedure, decreased from 79.5±29.6 to 26.2±18.5 mmHg (p<0.0001). A significant LVOT gradient reduction was achieved in 51 (86%) patients. A complete a-v block occurred in 17 (29%) patients, of whom 7 (12%) underwent dual-chamber pacemaker implantation. A significant decrease in exertional dyspnea and angina was observed three months after NSMR (NYHA class reduction from 2.9±0.2 to 1.4±0.7, p=0.001 and CCS class reduction from 2.3±0.3 to 0.5±0.7, p=0.001, respectively). Of the 45 patients who were followed for ≥3 years, one patient died due to lung disease whereas no sudden deaths or life-threatening ventricular arrhythmias were observed. LVOT gradient was further reduced, and three years after NMSR disappeared in 35 (59%) patients. A significant improvement in physical capacity was noted (peakVO2 increased from 14.1±3.8 ml/kg/min before NSMR to 23.2±6.2 three years later, p=0.02). Favourable LV remodelling was observed, causing LVOT dilatation and an increase in LV diastolic volume.
Conclusions: Because NSMR causes a significant reduction of LVOT gradient, an increase in physical capacity in >80% of patients and the long-term follow-up is uneventful, it may be regarded as an alternative procedure to myectomy in the treatment of patients with HOCM.
Get Citation

Keywords

hypertrophic obstructive cardiomyopathy - left ventricular outflow tract obstruction - non-surgical septal reduction

About this article
Title

Early and long-term results of non-surgical septal reduction in patients with hypertrophic cardiomyopathy

Journal

Kardiologia Polska (Polish Heart Journal)

Issue

Vol 59, No 10 (2003)

Pages

276-281

Published online

2005-12-12

Bibliographic record

Kardiol Pol 2003;59(10):276-281.

Keywords

hypertrophic obstructive cardiomyopathy - left ventricular outflow tract obstruction - non-surgical septal reduction

Authors

Lidia Chojnowska
Witold Rużyłło
Adam Witkowski
Beata Kuśmierczyk-Droszcz
Cezary Kępka
Marek Konka
Longina Małecka
Maciej Karcz
Janina Stępińska

Important: This website uses cookies. More >>

The cookies allow us to identify your computer and find out details about your last visit. They remembering whether you've visited the site before, so that you remain logged in - or to help us work out how many new website visitors we get each month. Most internet browsers accept cookies automatically, but you can change the settings of your browser to erase cookies or prevent automatic acceptance if you prefer.

By "Via Medica sp. z o.o." sp.k., Świętokrzyska 73 street, 80–180 Gdańsk, Poland

tel.:+48 58 320 94 94, faks:+48 58 320 94 60, e-mail: viamedica@viamedica.pl