Percutaneous Transluminal Septal Myocardial Ablation Research Articles

Percutaneous transluminal septal myocardial ablation for persistant left ventricular outflow tract obstruction after combined aortic valve replacement and septal myectomy in severe aortic stenosis

Percutaneous transluminal septal myocardial ablation for persistant left ventricular outflow tract obstruction after combined aortic valve replacement and septal myectomy in severe aortic stenosis

A case of recurrent hypertrophic obstructive cardiomyopathy treated successfully by the redo of percutaneous transluminal septal myocardial ablation

A case of recurrent hypertrophic obstructive cardiomyopathy treated successfully by the redo of percutaneous transluminal septal myocardial ablation

Survival After Alcohol Septal Ablation in Patients With Hypertrophic Obstructive Cardiomyopathy

BackgroundAlcohol-induced infarction for treatment of symptomatic hypertrophic obstructive cardiomyopathy (HOCM) was discussed as a risk factor for increased cardiac mortality during follow-up. ObjectivesThis study sought to report on long-term survival after echo-guided alcohol septal ablation (percutaneous transluminal septal myocardial ablation [PTSMA]) in symptomatic patients with HOCM. MethodsBetween May 2000 and June 2017, PTSMA with alcohol injection was performed in 952 patients (age 55.7 ± 14.9 years; 59.2% men; 73.3% New York Heart Association functional class III or IV; 50.3% syncope; 10.3% sudden cardiac death in family). Clinical follow-up after 6.0 ± 5.0 years was achieved in all patients. ResultsWe injected 2.1 ± 0.4 cc of alcohol. Maximal creatine kinase rise was 872 ± 489 U/l. Two (0.21%) patients died 3 and 33 days after ablation. Permanent pacemaker was implanted in 100 (10.50%) patients. Echo gradients were acutely reduced from 63.9 ± 38.2 mm Hg to 33.6 ± 29.8 mm Hg at rest and from 104.6 ± 44.0 mm Hg to 56.5 ± 41.0 mm Hg at Valsalva (p < 0.0001, each). During follow-up, 164 (17.2%) patients underwent reablation due to the planned staged procedure, 18 (1.9%) patients underwent surgical myectomy, and 49 (5.10%) patients underwent cardioverter-defibrillator implantation. Seventy patients died: causes of death were identified as noncardiovascular in 50, stroke related in 6, and cardiac in 14 patients. Estimated 5-year survival was 95.8%, estimated 5-year survival free of cardiovascular events was 98.6%, and an estimated 5-year survival free of cardiac events was 98.9%. Corresponding values at 10 years were 88.3%, 96.5%, and 97.0%, and at 15 years were 79.7%, 92.3%, and 96.5%. ConclusionsIn this study, PTSMA could be proofed as a safe procedure with ongoing symptomatic improvement and excellent long-term survival. Therefore, PTSMA is a reasonable alternative to surgical myectomy in HOCM.

Contemporary Septal Reduction Therapy in Drug-Refractory Hypertrophic Obstructive Cardiomyopathy.

Hypertrophic cardiomyopathy (HCM) is a complex and relatively common genetic cardiac disease that has been the subject of intense investigation for over 50 years. Most patients with HCM are asymptomatic, but some develop symptoms, often many years after the appearance of electrocardiographic or echocardiographic evidence of left ventricular hypertrophy. Symptoms due to the left ventricular outflow tract obstruction frequently worsen over time, requiring septal reduction therapy (SRT) despite optimal medical therapy. Percutaneous transluminal septal myocardial ablation (PTSMA) and surgical myectomy are collectively known as SRT. In this review, we will focus on the emerging concept and practical implication of SRT and the available evidence on either PTSMA or surgical myectomy in the literature.

Comparison of Clinical Effects between Percutaneous Transluminal Septal Myocardial Ablation and Modified Morrow Septal Myectomy on Patients with Hypertrophic Cardiomyopathy

Background:Percutaneous transluminal septal myocardial ablation (PTSMA) and modified Morrow septal myectomy (MMSM) are two invasive strategies used to relieve obstruction in patients with hypertrophic cardiomyopathy (HCM). This study aimed to determine the clinical outcome of these two strategies.Methods:From January 2011 to January 2015, 226 patients with HCM were treated, 68 by PTSMA and 158 by MMSM. Both ultrasonic cardiograms and heart functional class were recorded before, after operations and in the follow-up. Categorical variables were compared using Chi-square or Fisher's exact tests. Quantitative variables were compared using the paired samples t-test.Results:Interventricular septal thickness was significantly reduced in both groups (21.27 ± 4.43 mm vs. 18.72 ± 4.13 mm for PTSMA, t = 3.469, P < 0.001, and 21.83 ± 5.03 mm vs. 16.57 ± 3.95 mm for MMSM, t = 10.349, P < 0.001, respectively). The left ventricular outflow tract (LVOT) pressure gradient (PG) significantly decreased after the operations in two groups (70.30 ± 44.79 mmHg vs. 39.78 ± 22.07 mmHg for PTSMA, t = 5.041, P < 0.001, and 74.58 ± 45.52 mmHg vs. 13.95 ± 9.94 mmHg for MMSM, t = 16.357, P < 0.001, respectively). Seven patients (10.29%) in the PTSMA group required a repeat operation in the follow-up. Eight (11.76%) patients were evaluated for New York Heart Association (NYHA) III/IV in the PTSMA group, which was significantly more than the five (3.16%) in the same NYHA classes for the MMSM group at follow-up. Less than 15% of patients in the PTSMA group and none of the patients in the MMSM group complained of chest pain during follow-up.Conclusions:Both strategies can not only relieve LVOT PG but also improve heart function in patients with HCM. However, MMSM might provide a more reliable reduction in gradients compared to PTSMA.

Alcohol in the heart, mostly poison and sometimes a cure: percutaneous transluminal septal myocardial ablation

Alcohol in the heart, mostly poison and sometimes a cure: percutaneous transluminal septal myocardial ablation

Comparison of early clinical effects of ablation with surgery treatment in patients with hypertrophic cardiomyopathy

Objective: To compare the early clinical effect of septal myectomy and percutaneous transluminal septal myocardial ablation (PTMSA) on the left ventricular outflow obstruction and the rate of complication in patients with hypertrophic obstructive cardiomyopathy (HOCM). Methods: A total of 204 patients with HOCM who received septal reduction treatment were recruited. These patients were divided into two groups, surgery group (n=135) (65 patients with modified Morrow procedure, 70 patients with non-Morrow myomectomy) and PTMSA group (n=69). The baseline characteristics, disease status, other history of surgery and echocardiography parameters before and after septal reduction were collected, as well as the complication within 1 week after operation. Results: The mean age in surgery group was (46±14) years old, with 76 males (56.3%); mean age was (47±11) years old and with 51 males (73.9%) in PTMSA group. There was no significant difference in age, gender, the time of symptom and diagnosis, syncope, family history and atrial fibrillation between the two groups (all P>0.05). The proportion of mitral valve prolapse in the surgery group was higher than that in PTMSA group (75.8% vs 44.2%, P<0.05). Baseline left ventricular outflow tract (LVOT) gradient was comparable (82.7 mmHg in surgery group vs 77.7 mmHg in PTMSA group, P>0.05). The mean resting LVOT gradient after septal reduction therapy was lower (16.55 mmHg in surgery group, 26.68mmHg in PTMSA group) than that before operation, with lower gradient in surgery group (P<0.05). Compared with PTMSA group, the duration of hospitalization was longer in surgery group (P<0.05). There was similar rate of operation related complications in the two groups. Conclusions: Both septal reduction therapies can improve the LVOT obstruction, more significant in surgery group, but with longer hospital stay. The rate of operation related complication is similar in both groups.

One-year outcomes of percutaneous transluminal septal myocardial ablation and septal myectomy: A comparative study

One-year outcomes of percutaneous transluminal septal myocardial ablation and septal myectomy: A comparative study

Percutaneous transluminal septal myocardial ablation by microsphere embolisation for a patient with hypertrophic obstructive cardiomyophthy

Percutaneous transluminal septal myocardial ablation by microsphere embolisation for a patient with hypertrophic obstructive cardiomyophthy

Ameliorating the severity of sleep-disordered breathing concomitant with heart failure status after percutaneous transluminal septal myocardial ablation for drug-refractory hypertrophic obstructive cardiomyopathy.

The coexistence of sleep-disordered breathing (SDB) and hypertrophic obstructive cardiomyopathy (HOCM) has widely been recognized; however, the impact of percutaneous transluminal septal myocardial ablation (PTSMA) for HOCM on SDB remains unknown. Herein, we examine cardiorespiratory polygraph parameters in patients with drug-refractory HOCM before and after PTSMA. Forty consecutive drug-refractory HOCM patients, admitted to Keio University Hospital, and who underwent cardiorespiratory polygraphy were retrospectively analyzed. Cardiorespiratory polygraphy was performed before and after PTSMA if patients underwent PTSMA. Patients with an apnea-hypopnea index (AHI) ≥5/h were considered to have SDB. The total number of central sleep apneas, obstructive sleep apneas, and hypopnea events was evaluated. Thirty-two out of 40 patients (80%) with drug-refractory HOCM had SDB. All patients experienced relief of heart failure-associated symptoms after PTSMA. The severity of SDB was found to be correlated with left atrial diameter. The AHI decreased after PTSMA [before 15.4 (range 10.9-23.5)/h vs. after 13.1 (8.3-17.8)/h, P=0.02]. Especially, the hypopnea index decreased after PTSMA. The average and lowest arterial oxygen saturation also increased after PTSMA (94.2±1.9-95.7±1.6%, P=0.009; 81.3±5.7-85.8±4.8%, P=0.012, respectively). In patients with drug-refractory HOCM, PTSMA decreased the AHI and improved arterial oxygen saturation measures. Thus, invasive treatment of the left ventricular obstruction ameliorates the severity of SDB, in addition to improving heart failure status.

TCTAP C-178 Evaluation with Computed Tomography of Percutaneous Transluminal Septal Myocardial Ablation in Hypertrophic Obstructive Cardiomyopathy

TCTAP C-178 Evaluation with Computed Tomography of Percutaneous Transluminal Septal Myocardial Ablation in Hypertrophic Obstructive Cardiomyopathy

Procedural Complication Rates of Percutaneous Transluminal Septal Myocardial Ablation for Hypertrophic Obstructive Cardiomyopathy

Background: Percutaneous Transluminal Septal Myocardial Ablation (PTSMA) can relieve symptoms of HOCM. We report immediate procedural outcomes at a tertiary centre over a 16-year period. Methods: Consecutive patients presenting for PTSMA from 2000-2016 were retrospectively analysed. All underwent coronary angiography to assess for suitable septal sub-branches. If appropriate, PTSMA was performed separately under GA with transoesophageal myocardial contrast echocardiographic (MCE) guidance. Results: 85 patients (age 60 ± 15yrs, 52% male) were considered; of these, 9 were excluded (2 - septals too small, 2 - balloons could not be delivered into septals, and 5 - echocardiographic opacification of inappropriate myocardium due to extensive septal collaterals). 76 patients (89.4%) proceeded (mean procedural time 106 ± 24mins). An average of 2.2 ± 0.6 ml alcohol was injected into 1.1 ± 0.4 septal perforators. Ventricular arrhythmias necessitating cardioversion occurred in 3 patients (3.9%). Anterior MI due to LAD artery no-reflow occurred in 2 (2.6%). Tamponade occurred in 1 patient (1.3%) after removal of TPW. 14/64 patients (21.9%) required PPM implantation due to CHB. There were no ventricular septal ruptures or intra-procedural deaths. One patient (1.3%) died 3 days post following haemorrhagic stroke. Compared with baseline, PTSMA led to an immediate reduction in resting (51 ± 41 vs 82 ± 50 mmHg; p = 0.0001) and provoked (65 ± 44 vs 96 ± 37 mmHg; p = 0.0002) LVOT gradients. Peak troponin and CK were 33 ± 27 (ug/L) and 1295 ± 792 (U/L) respectively. Conclusion: Sub-selective PTSMA guided by MCE is an effective treatment for reducing LVOT gradients in symptomatic patients with HOCM. Technically feasible in most patients, procedural success can be achieved safely with 2.2 ml of alcohol.

The Efficacy of Percutaneous Transluminal Septal Myocardial Ablation of Clinical Outcomes: A 16-Year Single-Centre Australian Experience

Background: Percutaneous transluminal septal myocardial ablation (PTSMA) is a recognised option for the relief of symptoms in patients with HOCM. However, data are limited regarding long-term procedural safety and efficacy. We report long-term clinical and echocardiographic outcomes. Methods: Consecutive patients from 2000-2016 were analysed retrospectively. All procedures were performed by a single operator, with myocardial contrast echocardiographic guidance for appropriate selection of septal sub-branches. Clinical follow-up (FU) and echocardiography was performed at 2 days, 6 weeks, 6 months, 12 months and yearly thereafter. Results: 76 patients (mean age 60 ± 15 yrs; 50% male) underwent PTSMA with median FU of 90 (range 3-182) months. Long-term data were not available on 10 patients. Mortality was 1.3% (1/76) in hospital. Survival at most recent FU was 93.4% (61/66). Of 5 deaths, 2 were cardiovascular (CV)–heart failure related, and 3 non-cardiovascular. Compared to baseline (19.8 ± 4.4 mm), septal thickness was statistically significantly reduced at all intervals; 6wk - 18.4 ± 4.9 mm; 6mnth - 17.7 ± 5.5 mm; 1yr - 17.7 ± 5.8 mm; most recent - 16.0 ± 4.9 mm, indicating progressive remodelling. Compared with baseline (81.7 ± 49.6 mmHg), resting LVOT gradients were statistically significantly reduced at all points; 2 days - 51.4 ± 40.9 mmHg; 6wk - 31.8 ± 37.4 mmHg; 6mnth - 28.5 ± 30.4 mmHg; 1yr - 27.4 ± 32.4 mmHg; most recent - 11.8 ± 21.1 mmHg. At most recent FU, NYHA class improved from 3 to 1 (p = 0.004) and CCS class from 2 to 1 (p = 0.08). Conclusion: PTSMA is a safe and effective treatment for relief of symptoms in patients with HOCM. Our data demonstrates sustained reductions in both IVS thickness and resting LVOT gradients at 8 years post-procedure.

ECG Changes and Rhythm Disturbances Following Percutaneous Transluminal Septal Myocardial Ablation for Hypertrophic Obstructive Cardiomyopathy

ECG Changes and Rhythm Disturbances Following Percutaneous Transluminal Septal Myocardial Ablation for Hypertrophic Obstructive Cardiomyopathy

TCT-812 Long Term Clinical and Echocardiographic Outcomes following Percutaneous Transluminal Septal Myocardial Ablation for Hypertrophic Obstructive Cardiomyopathy: a 16 Year Single-Centre Australian Experience

Percutaneous Transluminal Septal Myocardial Ablation (PTSMA) is a recognized option for the relief of symptoms in patients with HOCM. However, data are limited regarding long-term procedural safety & efficacy. We report long-term clinical & echocardiographic outcomes in patients undergoing PTSMA in

Significant reduction of left atrial volume concomitant with clinical improvement after percutaneous transluminal septal myocardial ablation for drug-refractory hypertrophic obstructive cardiomyopathy, and its precise detection with multidetector CT

ObjectiveIn patients with hypertrophic obstructive cardiomyopathy (HOCM), left atrial (LA) volume measurement is very important to provide prognostic information. Recent studies demonstrated that multidetector CT (MDCT) is useful to assess...

TCTAP C-245 Usefulness of Reverse Wire Technique for Septal Branch Selection During Percutaneous Transluminal Septal Myocardial Ablation

### Patient initials or identifier number 0020248389 ### Relevant clinical history and physical exam A 73 years-old female with bronchial asthma developed dyspnea on effort (DOE) and visted a hospital. She was diagnosed with hypertrophic obstructive cardio myopathy (HOCM) and administered

Two Cases of Hypertrophic Obstructive Cardiomyopathy Treated with Second Therapy of Percutaneous Transluminal Septal Myocardial Ablation (PTSMA)

A 50 year old male was diagnosed with hypertrophic cardiomyopathy (HCM). He showed a sign of heart failure which is resistant to drug therapy (atenolol 50mg, cibenzoline 300mg/day). Echocardiography revealed left ventricular hypertrophy with preserved systolic function, severe left ventricular outflow tract obstruction (maximal pressure gradient was 184 mmHg). We performed percutaneous transluminal septal myocardial ablation (PTSMA). Clinical symptoms was improved after first PTSMA, whereas there was no change of left ventricular outflow tract obstruction at echocardiography. He was admitted to hospital for heart failure two years later after first PTSMA. We performed second PTSMA. The procedure resulted in an acceptable hemodynamic result (residual pressure gradient was 20 mmHg) and improvement of clinical symptoms (NYHA class 4 to 2, BNP 542 to 87pg/ml). 52 year old women was diagnosed with HOCM (maximal pressure gradient was 100 mmHg), treated with bisoprolol 2.5mg/day and cibenzoline 300mg/day. We performed first PTSMA. Echocardiography revealed improvement of maximal pressure gradient (NYHA 100 to 30mmHg). She was admitted for heart failure 4 months later after first PTSMA. Maximal pressure gradient was 140 mmHg, so we performed second PTSMA. The procedure resulted in an acceptable hemodynamic result (residual pressure gradient was 40 mmHg) and improvement of clinical symptoms (NYHA class 3 to 1, BNP 188 to 46 pg/ml).

A Successful Case of Percutaneous Transluminal Septal Myocardial Ablation for the Left Ventricular Outflow Tract Obstruction after Mitral Valve Replacement

A Successful Case of Percutaneous Transluminal Septal Myocardial Ablation for the Left Ventricular Outflow Tract Obstruction after Mitral Valve Replacement

“Moving left ventricular obstruction” due to stress cardiomyopathy in a patient with hypertrophic obstructive cardiomyopathy treated with percutaneous transluminal septal myocardial ablation

“Moving left ventricular obstruction” due to stress cardiomyopathy in a patient with hypertrophic obstructive cardiomyopathy treated with percutaneous transluminal septal myocardial ablation☆ Keitaro Akita , YuichiroMaekawa ⁎, Hikaru Tsuruta , Shigeo Okuda , Ryo Yanagisawa , Toshimi Kageyama , Takashi Kawakami , Hideaki Kanazawa , Kentaro Hayashida , Shinsuke Yuasa , Mitsushige Murata , Masahiro Jinzaki , Keiichi Fukuda a