This Article Full Text (PDF) 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 Google Scholar Google Scholar Articles by Kuhn, H. J. Articles by Sigwart, U. Search for Related Content PubMed PubMed Citation Articles by Kuhn, H. J. Articles by Sigwart, U.

(Circulation. 1998;97:709-710.)
© 1998 American Heart Association, Inc.

Correspondence

Induced Septal Infarction/Nonsurgical Septal Reduction for Hypertrophic Obstructive Cardiomyopathy

Horst J. Kuhn, MD, FESC

Professor of Internal Medicine/Cardiology, Department of Internal Medicine/Cardiology, The Bielefeld Hospital, Bielefeld, Germany

To the Editor:

Eugene Braunwald¹ calls the new catheter interventional therapy for hypertrophic obstructive cardiomyopathy (HOCM) an ingenious approach with quite favorable results.

Braunwald states that we have reproduced the results obtained by Knight et al² both with transient ischemia and ethanol-induced infarction and that Sigwart et al³ demonstrated in 1982 that brief occlusion of the septal artery with a balloon catheter causes transient reduction in the outflow pressure gradient. Knight et al² state that Sigwart's findings⁴ were confirmed by us.⁵

However, checking the papers and/or abstracts published by Sigwart, the opposite proves to be the case:

1. In both articles,^{3 4} there is nothing written about HOCM or septal artery occlusion in HOCM. Both papers deal with the effect of transient therapeutic occlusion of the left anterior descending coronary artery (LAD) in patients with coronary artery disease.

2. Sigwart confirms that he has never published data regarding septal artery occlusion performed in 1982. He calls them unpublished "prior art."⁶

3. A study to develop a new catheter-based concept of treatment for patients with HOCM including the suggestion to inject 96% ethanol was first published by us in April 1994,^{7 9} ie, 15 months before the first paper by Sigwart.⁸

As has been appreciated,^{5 7 9} a catheter-induced septal necrosis by the injection of alcohol into a septal branch of the LAD was first performed by Brugada et al¹⁰ in patients with coronary artery disease for chemical ablation of ventricular tachycardia. This study stimulated us to begin development of the new catheter-based concept of treatment in 1991.⁹

It seems necessary to me to note that for historical reasons, to date the new approach (transcoronary ablation of septum hypertrophy, or TASH) has been performed by us in more than 1180 patients with favorable results.

References

1. Braunwald E. Editorial. Induced septal infarction: a new therapeutic strategy for hypertrophic obstructive cardiomyopathy. Circulation. 1997;95:1981–1982.
   
2. Knight C, Kurbaan AS, Seggewiss H, Henein M, Gunning M, Harrington D, Fassender D, Gleichmann U, Sigwart U. Nonsurgical septal reduction for hypertrophic obstructive cardiomyopathy: outcome in the first series of patients. Circulation. 1997;95:2075–2081.
   
3. Sigwart U, Grbic M, Essinger A, Rivier JL. L'effect aigu d'une occlusion coronarienne par ballonet de la dilatation transluminale. Schweiz Med Wochenschr. 1982;45:1631. Abstract.
   
4. Sigwart U, Grbic M, Payot M, Essinger A, Sadeghi H. Wall motion during balloon occlusion. In: Sigwart U, Heinzen PH, eds. Ventricular Wall Motion. New York, NY: Georg Thieme; 1983:206–210.
   
5. Gietzen F, Leuner C, Gerenkamp T, Kuhn H. Relief of obstruction in hypertrophic cardiomyopathy by transient occlusion of the first septal branch of the left coronary artery. Eur Heart J. 1994;15:125. Abstract.
   
6. Sigwart U. Therapie der hypertrophen obstruktiven Kardiomyopathie. Dtsch Med Wochenschr. 1997;122:495. Reply No. 2 (correspondence).
   
7. Gietzen F, Leuner C, Gerenkamp T, Kuhn H. Abnahme der Obstruktion bei hypertrophischer Kardiomyopathie während passagerer Okklusion des ersten Septalastes der linken Koronararterie. Z Kardiol. 1994;83(suppl 1):146. Abstract.
   
8. Sigwart U. Nonsurgical myocardial reduction for hypertrophic obstructive cardiomyopathy. Lancet. 1995;346:211–214.
   
9. Kuhn H, Gietzen F, Leuner C, Gerenkamp T. Induction of subaortic septal ischemia to reduce obstruction in hypertrophic obstructive cardiomyopathy: studies to develop a new catheter-based concept of treatment. Eur Heart J. 1997;18:846–851.
   
10. Brugada P, de Swart H, Smeets JL, Wellens H. Transcoronary chemical ablation of ventricular tachycardia. Circulation. 1989;79:475–482.
    

Response

Ulrich Sigwart, MD, FRCP, FACC, FESC

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

Dr Kuhn's remarks relate to the problem of intellectual property. The method of nonsurgical septal reduction in hypertrophic obstructive cardiomyopathy through creation of a localized necrosis¹ was indeed conceived more than 10 years prior to Dr Kuhn's suggestion, which was published in 1994.²

Also, the very first alcohol ablation of the septal bulge in hypertrophic obstructive cardiomyopathy was performed before the publication of the abstract² in which Dr Kuhn hinted that alcohol injection into septal branches might be feasible.

The first cases of transient balloon occlusion of septal arteries in hypertrophic obstructive cardiomyopathy (1982 and 1983) were the basis for the Ethics Committee's approval in 1992 in London. Without this "prior art," this approval would not have been granted. The feasibility of a temporary septal branch balloon occlusion was demonstrated through observations obtained in 1981 and 1982 and published in 1982 and 1983.^{3 4} Dr Braunwald's conclusion regarding the sequence of investigations leading to the first clinical application of nonsurgical septum reduction is therefore eminently justified.⁵

Finally, I am delighted to see the technique has caught sufficient interest to justify these statements.

References

1. Kuhn H, Gietzen F, Leuner C, Gerenkamp T. Induction of subaortic septal ischemia to reduce obstruction in hypertrophic obstructive cardiomyopathy: studies to develop a new catheter-based concept of treatment. Eur Heart J. 1997;18:846–851.
   
2. Gietzen F, Leuner C, Gerenkammp T, Kuhn H. Abnahme der obstruktion bei hypertrophischer Kardioyopathie während passagerer Okklusion des ersten Septalastes der linken Koronararterie. Z Kardiol. 1994;83(suppl 1):146. Abstract.
   
3. Sigwart U, Grbic M, Essinger A, Rivier JL. L'effect aigu d'une occlusion coronarienne par ballonet de la dilatation transluminale. Schweiz Med Wochenschr. 1982;45:1631. Abstract.
   
4. Sigwart U, Grbic M, Payot M, Essinger A, Sadeghi H. Wall motion during balloon occlusion. In: Sigwart U, Heinzen PH, eds. Ventricular Wall Motion. New York, NY: Georg Thieme; 1983:206–210.
   
5. Braunwald E. Induced septal infarction: a new therapeutic strategy for hypertrophic obstructive cardiomyopathy. Circulation. 1997;95:1981–1982.
   

This Article Full Text (PDF) 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 Google Scholar Google Scholar Articles by Kuhn, H. J. Articles by Sigwart, U. Search for Related Content PubMed PubMed Citation Articles by Kuhn, H. J. Articles by Sigwart, U.