Interv Akut Kardiol. 2010;9(1):20-26

Alcohol septal ablation vs. surgical myectomy in the treatment of hypertrophic obstructive cardiomyopathy

Miloslav Brtko¹, Jan Vojáček¹, Josef Šťásek², Jan Vojáček², Pavel Polanský¹, Martin Tuna¹, Josef Bis², Jaroslav Dušek²

¹ Kardiocentrum, Kardiochirurgická klinika LF UK a FN, Hradec Králové

² I. interní klinika, LF UK a FN, Hradec Králové

Hypertrophic cardiomyopathy is an autosomal dominant disease with prevalence of 0,2 % and with asymetric hypertrophy of left ventricle

(> 15 mm). Obstructive form is clinically more significant and has worse prognosis. As a cause of this disease more than 200 mutations on

more than 10 genes were diagnosed till now. Symptomatology and prognosis of hypertophic cardiomyopathy is heterogenous – from

asymptomatic course to sudden death. Angina pectoris, effort dyspnoe or syncope are the most common symptoms. Mortality is estimated

1 % to 6 %. Obstructive form is characterized by resting or provoked gradient > 30 mm Hg. In patients with obstructive form the risk

of death, stroke and heart failure is higher as well as the risk of disease progression into the NYHA class III or IV. In the treatment of this

disease drugs, A-V sequential stimulation, surgical myectomy or alcohol septal ablation (ASA) are used. The most effective treatment of

obstructive form are surgical myectomy and ASA. Both methods are connected with low mortality, both procedures significantly improve

symptomatology of the patients, surgical myectomy improves patient´s prognosis. Lowering of resting and provoked gradients, favourable

remodeling of the left ventricle and the left atrium, decreasing of the severity of SAM and increasing of effort tolerance are seen during

follow-up. A-V block with permanent pacemaker implantation and right bundle branch block are more common after ASA, left bundle

branch block is more common after surgical myectomy. Aortic valve insufficiency, atrial fibrilation and stroke are sparse complications of

surgical myectomy. ASA is performed more often in older polymorbid patients, surgical myectomy in younger patients with associated

aortic or mitral valve disease. The principles and comparison of both methods from many perspectives are given in this review.

Keywords: hypertrophic cardiomyopathy, alcohol septal ablation, septal myectomy

Published: March 1, 2010  Show citation