Percutaneous transluminal septal alcoholization for the treatment of refractory hypertrophic obstructive cardiomyopathy: initial experience in the Federal District.

OBJECTIVE

To analyze the efficacy of percutaneous transluminal septal alcoholization in the treatment of refractory obstructive hypertrophic cardiomyopathy (HOC).

METHODS

The patients were referred for alcoholization after Doppler echocardiography. Before and after alcoholization, the intraventricular pressure gradient was recorded. Alcoholization was performed with a 3mL injection of absolute alcohol through a coronary angioplasty balloon catheter. The procedure was concluded after a significant reduction or abolition of the pressure gradient.

RESULTS

Of 22 patients, 18 (81.8%) successfully concluded the procedure with a reduction in intraventricular pressure gradient at baseline (from 67.6+/-24.2 mmHg to 3.8+/-1.9 mmHg, p<0.005) and after extrasystole (from 110.4+/-24.2 mmHg to 9.6+/-2.6 mm Hg, p<0.005). A significant reduction in mean interventricular septal thickness (from 2+/-0.3 mm to 1.7+/-0.2 mm, p<0.005) and in peak pressure gradient (from 90.7+/-23.5 mmHg to 6.1+/-1.4 mmHg, p<0.005) was observed on Doppler echocardiography after 6 months, when all patients were in functional class I. The most frequent acute complication, present in 11% of the patients, was the need for definitive pacing implantation. Relapse of the symptoms and reappearance of the pressure gradient occurred in 16.6% of the patients. One patient (5.5%) died probably due to a diffuse coronary spasm prior to the procedure, and another died suddenly on late follow-up.

CONCLUSION

Percutaneous transluminal septal alcoholization is effective and safe in the treatment of HOC.