This Article Full Text Alert me when this article is cited Alert me if a correction is posted 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 Hamada, M. Articles by Anderson, R. Search for Related Content PubMed PubMed Citation Articles by Hamada, M. Articles by Anderson, R.

(Circulation. 1998;98:377-378.)
© 1998 American Heart Association, Inc.

Correspondence

Clinical Significance of Obstruction of the First Major Septal Branch

Mareomi Hamada, MD; Koji Kodama, MD; ; Kunio Hiwada, MD

The Second Department of Internal Medicine, Ehime University School of Medicine, Ehime, Japan

To the Editor:

The first major septal branch of the left anterior descending coronary artery seems to be closely related to disorder of the conduction system. Blood supply to the anterosuperior fascicle of the left bundle branch originates exclusively from the septal branches.¹ During myocardial ischemic attack due to stenosis of the proximal left anterior descending coronary artery, from the ostium of the left coronary artery to just before the first major septal branch, left-axis deviation often appears.^{2 3 4} Very recently, we reported⁵ that transient leftward QRS-axis shift during treadmill exercise testing or PTCA was a highly specific marker of proximal left anterior descending coronary artery disease. However, no one has confirmed that this left-axis deviation associated with myocardial ischemia is due to ischemia of the first septal branch.

Recently, Knight et al⁶ reported that nonsurgical septal reduction due to selective intracoronary alcohol injection into the first major septal branch reduced left ventricular outflow tract obstruction and improved symptoms in patients with hypertrophic obstructive cardiomyopathy. They also reported the ECG changes associated with this procedure. The most common ECG change was the development of right bundle-branch block (11 of 13 patients). Right bundle-branch block was accompanied by anterior ST-segment elevation in 3 patients and by the development of anterior Q waves in another 2. Two patients developed ventricular arrhythmias and 4 experienced transient complete heart block after injection of alcohol. We are very interested in the occurrence of right bundle-branch block and transient complete heart block.

The procedure performed by Knight . . . [Full Text of this Article]

Ulrich Sigwart, MD, FRCP, FESC; Derek Gibson, MD, FRCP, FESC; Michael Henein, MD; ; Robert Anderson, MD, FRCP, FESC

Royal Brompton Hospital, Department of Invasive Cardiology, London, England

This article has been cited by other articles:

				W Ruzyllo, L Chojnowska, M Demkow, A Witkowski, B Kusmierczyk-Droszcz, W Piotrowski, L Rausinska, M Karcz, L Malecka, and W Rydlewska-Sadowska Left ventricular outflow tract gradient decrease with non-surgical myocardial reduction improves exercise capacity in patients with hypertrophic obstructive cardiomyopathy Eur. Heart J., May 1, 2000; 21(9): 770 - 777. [Abstract] [PDF]

				M. Y. Henein, C. A. O'Sullivan, I. S. Ramzy, U. Sigwart, and D. G. Gibson Electromechanical left ventricular behavior after nonsurgical septal reduction in patients with hypertrophic obstructive cardiomyopathy J. Am. Coll. Cardiol., October 1, 1999; 34(4): 1117 - 1122. [Abstract] [Full Text] [PDF]