Echocardiography-Guided Ethanol Septal Reduction for Hypertrophic Obstructive Cardiomyopathy

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Abstract
Background —Left ventricular outflow tract (LVOT) obstruction is frequently responsible for symptoms in hypertrophic obstructive cardiomyopathy (HOCM). Medical therapy is often not sufficient to control these symptoms, and surgical myotomy-myomectomy is required. Methods and Results —We enrolled 33 symptomatic patients with HOCM and obstruction (≥40 mm Hg gradient at rest or ≥60 mm Hg dobutamine-provoked). By contrast echocardiography, the bulging septum was localized and infarcted by injection of 2 to 5 mL of absolute ethanol into the septal artery(ies) supplying the hypertrophied area. Baseline echocardiograms with Doppler, myocardial perfusion tomograms, and treadmill exercise or pharmacological testing were compared with those at 6 weeks and 6 months. The mean rise in creatine kinase was 1964±796 U. All patients experienced symptomatic relief; NYHA class decreased from 3.0±0.5 to 0.9±0.6 ( P P =0.03). The resting and dobutamine-provoked gradient decreased from 49±33 and 96±34 mm Hg to 9±19 ( P P Conclusions —Echocardiography-guided ethanol septal reduction in patients with HOCM is a safe, minimally invasive procedure that provides symptomatic relief with improved hemodynamic and left ventricular parameters.