Annals of thoracic surgery short reports · 2024
Septal Myectomy for Isolated Midventricular Obstruction After Alcohol Septal Ablation for Obstructive Hypertrophic Cardiomyopathy.
СтатьяНазвание и аннотация: Перевод в очереди
Обработка статьи · этапы, ошибки и управление
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Karadzha Anastasiia, Schaff Hartzell V
Аннотация
BACKGROUND: Alcohol septal ablation is an alternative to surgical myectomy for septal reduction in obstructive hypertrophic cardiomyopathy, particularly in high-risk surgical patients. However, alcohol septal ablation can sometimes result in residual left ventricular obstruction, typically in the subaortic area and, much more rarely, in the midventricular region.
METHODS: This report presents 3 unique cases of isolated midventricular obstruction without systolic anterior motion that required surgical myectomy after alcohol septal ablation.
RESULTS: Three patients presented with persistent or recurrent symptoms of left ventricular outflow obstruction after alcohol septal ablation. Surgical myectomy, performed through a transapical approach alone or in combination with a transaortic approach, successfully reduced intracavitary gradients and septal thickness in all 3 patients. One patient underwent cardiac transplantation 2 years after septal myectomy due to diastolic heart failure without obstruction.
CONCLUSIONS: This case series highlights concerns about the use of alcohol septal ablation for patients with long-segment subaortic obstruction and midventricular involvement, suggesting that surgical myectomy may be a more suitable treatment option for this anatomic subtype.
METHODS: This report presents 3 unique cases of isolated midventricular obstruction without systolic anterior motion that required surgical myectomy after alcohol septal ablation.
RESULTS: Three patients presented with persistent or recurrent symptoms of left ventricular outflow obstruction after alcohol septal ablation. Surgical myectomy, performed through a transapical approach alone or in combination with a transaortic approach, successfully reduced intracavitary gradients and septal thickness in all 3 patients. One patient underwent cardiac transplantation 2 years after septal myectomy due to diastolic heart failure without obstruction.
CONCLUSIONS: This case series highlights concerns about the use of alcohol septal ablation for patients with long-segment subaortic obstruction and midventricular involvement, suggesting that surgical myectomy may be a more suitable treatment option for this anatomic subtype.