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(Circulation. 2005;112:450-452.)
© 2005 American Heart Association, Inc.

Editorial

Surgical Versus Alcohol Septal Ablation for Hypertrophic Obstructive Cardiomyopathy

The Pendulum Swings

Magdi H. Yacoub, FRS

From the Heart Science Centre, Imperial College London, London, United Kingdom.

Correspondence to Prof Sir Magdi Yacoub, Imperial College London, Heart Science Centre, Harefield, Middlesex UB9 6JH, UK. E-mail m.yacoub@imperial.ac.uk

Key Words: Editorials • ablation • cardiomyopathy • hypertrophy • surgery

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

	Introduction

 
Since the original description of hypertrophic cardiomyopathy by Donald Teare¹ and Lord Brock² nearly 50 years ago, management of this condition has attracted the attention of surgeons,^3–5 clinical and intervention cardiologists,^6–10 epidemiologists,¹¹ and, more recently, molecular biologists. To date, the emphasis has been directed toward symptomatic patients or those who are at high risk of dying or developing severe symptoms. The association between left ventricular outflow tract obstruction and poor outcome was recognized since the initial description of the condition, which resulted in Lord Brock attempting to surgically dilate the left ventricular outflow tract (LVOT). More recently it was shown that the LVOT obstruction is an independent predictor of progression to severe symptoms of heart failure and death,⁷ and this has stimulated additional intensive studies to define the exact pathophysiology of the obstruction. Although the main cause of the obstruction is the abnormal bulge of the interventricular septum into the outflow tract, the mitral valve plays an important role in producing the obstruction with echocardiographic demonstration of systolic anterior motion (SAM) of the mitral valve, SAM being an essential feature^12,13 of diagnosing obstruction. The cause of SAM is multifactorial and is thought to be produced by the Venturi effect, which is produced by acceleration of blood secondary to the septal bulge and upward displacement of the line of coaptation of the posterior to the anterior leaflet of the mitral valve, ending in a more mobile distal part of the anterior leaflet. Other factors include anterior displacement of the anterior papillary . . . [Full Text of this Article]

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