This Article Full Text Full Text (PDF) Alert me when this article is cited Alert me if a correction is posted Citation Map Services Email this article to a friend Similar articles in this journal Similar articles in PubMed Alert me to new issues of the journal Download to citation manager Request Permissions Citing Articles Citing Articles via HighWire Citing Articles via Google Scholar Google Scholar Articles by Kimmelstiel, C. D. Articles by Maron, B. J. Search for Related Content PubMed PubMed Citation Articles by Kimmelstiel, C. D. Articles by Maron, B. J. Related Collections Hypertrophy Myocardial cardiomyopathy disease Ablation/ICD/surgery Catheter-based coronary and valvular interventions: other CV surgery: transplantation, ventricular assistance, cardiomyopathy

(Circulation. 2004;109:452-456.)
© 2004 American Heart Association, Inc.

Clinician Update

Role of Percutaneous Septal Ablation in Hypertrophic Obstructive Cardiomyopathy

Carey D. Kimmelstiel, MD; Barry J. Maron, MD

From the Hypertrophic Cardiomyopathy Center and Cardiac Catheterization Laboratory, Division of Cardiology, Tufts-New England Medical Center, Boston, Mass (C.D.K.), and The Hypertrophic Cardiomyopathy Center, Minneapolis Heart Institute Foundation, Minneapolis, Minn (B.J.M.).

Correspondence to Carey D. Kimmelstiel, MD, Tufts-New England Medical Center, 750 Washington St, Boston, MA 02111-5913. E-mail ckimmelstiel@tufts-nemc.org

An extract of the first 250 words of the full text is provided, because this article has no abstract.

	Introduction

 
Case Presentation: A 58-year-old diabetic man was referred for severe progressive exertional dyspnea consistent with New York Heart Association (NYHA) functional class III. Six years earlier, he underwent coronary artery bypass grafting, complicated by a sternal wound infection.

Physical examination was notable for a bifid carotid pulse and loud apical systolic ejection murmur. Echocardiography documented hyperdynamic left ventricular (LV) systolic function and asymmetric hypertrophy confined to the basal ventricular septum (measuring 20 mm in thickness) consistent with hypertrophic cardiomyopathy (HCM). Continuous wave Doppler estimated a 65 mm Hg subaortic gradient due to dynamic systolic anterior motion of the mitral valve with septal contact. Coronary angiography showed patent bypass grafts.

Medical management with ß-blockers and verapamil was ineffective in controlling symptoms. Catheter-based intervention was considered for this patient to reduce outflow obstruction and symptoms.

HCM is a relatively common genetic disease with important clinical consequences, including sudden death in the young and disability due to heart failure at any age.^1,2 It is estimated that progression to NYHA functional classes III/IV associated with obstruction to LV outflow occurs in about 10% of HCM patients who are limited largely by exertional dyspnea, chest pain, fatigue, and occasionally orthopnea or nocturnal dyspnea.^1,2 Long-term consequences of HCM attributable to outflow obstruction have been emphasized, particularly progression of disabling symptoms and death related to heart failure.²

	Therapeutic Options in Obstructive HCM

 
The traditional first line of therapy to improve quality of life in HCM patients with symptoms and outflow obstruction has been administration of negative inotropic agents, including ß-blockers, verapamil, . . . [Full Text of this Article]

This article has been cited by other articles:

				S. E. Whitten Systolic Heart Failure in a Patient With Hypertrophic Obstructive Cardiomyopathy: A Potentially Life-Threatening Complication Crit. Care Nurse, October 1, 2008; 28(5): 44 - 52. [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]

				V. L. Vetter, J. Elia, C. Erickson, S. Berger, N. Blum, K. Uzark, and C. L. Webb Cardiovascular Monitoring of Children and Adolescents With Heart Disease Receiving Medications for Attention Deficit/Hyperactivity Disorder: A Scientific Statement From the American Heart Association Council on Cardiovascular Disease in the Young Congenital Cardiac Defects Committee and the Council on Cardiovascular Nursing Circulation, May 6, 2008; 117(18): 2407 - 2423. [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]

				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]

				C. M. Boltwood Jr., W. Chien, and T. Ports Ventricular Tachycardia Complicating Alcohol Septal Ablation N. Engl. J. Med., October 28, 2004; 351(18): 1914 - 1915. [Full Text] [PDF]

				T. O. Cheng, C. D. Kimmelstiel, and B. J. Maron In Percutaneous Transluminal Septal Myocardial Ablation for Hypertrophic Obstructive Cardiomyopathy, It Is Not the Speed of Intracoronary Alcohol Injection But the Amount of Alcohol Injected That Determines the Resultant Infarct Size * Response Circulation, July 20, 2004; 110(3): e23 - e23. [Full Text] [PDF]