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Review
. 2021 Oct 1;23(11):165.
doi: 10.1007/s11886-021-01600-5.

Septal Ablation Versus Surgical Myomectomy for Hypertrophic Obstructive Cardiomyopathy

F Pelliccia  1 , H Seggewiss  2 , F Cecchi  3 , P Calabrò  4 , G Limongelli  4   5 , O Alfieri  6 , P Ferrazzi  7 , M H Yacoub  8 , I Olivotto  9
Affiliations
Review

Septal Ablation Versus Surgical Myomectomy for Hypertrophic Obstructive Cardiomyopathy

F Pelliccia et al. Curr Cardiol Rep. .

Abstract

Purpose of review: Patients with hypertrophic cardiomyopathy (HCM) who have left ventricular outflow tract obstruction (LVOTO) often experience severe symptoms and functional limitation. Relief of LVOTO can be achieved by two invasive interventions, i.e., surgery myectomy and alcohol septal ablation (ASA), leading in experienced hands to a dramatic improvement in clinical status. Despite extensive research, however, the choice of the best option in individual patients remains challenging and poses numerous clinical dilemmas.

Recent findings: Invasive strategies have been recently incorporated in recommendations for the diagnosis and treatment of HCM on both sides of the Atlantic. These guidelines are based on a bulk of well-designed but retrospective studies as well as on expert opinions. Evidence now exists that adequate evaluation and management of HCM requires a multidisciplinary team capable of choosing the best available options. Management of LVOTO still varies largely based on local expertise and patient preference. Following the trend that has emerged for other cardiac diseases amenable to invasive interventions, the concept of a "HCM heart team" is coming of age.

Keywords: Alcohol septal ablation; Gradient; Hypertrophic cardiomyopathy; Left ventricular outflow tract; Myectomy; Obstruction.

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Conflict of interest statement

No author has any conflict of interest to disclose.

Figures

Fig. 1
Fig. 1
Secondary chordal cutting in obstructive HCM: effects of secondary chordal cutting on the geometry and function of the mitral valve apparatus. A In patients with obstructive hypertrophic cardiomyopathy, fibrotic and retracted mitral valve secondary chordae contribute to displace the body of the anterior leaflet into the left ventricular outflow tract. B Cutting selected abnormal chordae (in combination with a shallow septal myectomy) moves the mitral valve apparatus and leaflet coaptation point away from the outflow tract to a more posterior and normal position in the left ventricular cavity, substantially increasing outflow tract size and decreasing mitral valve tenting area. C Isolated septal myectomy (i.e., without associated chordal cutting) does not alter the anterior displacement of the mitral valve apparatus. Ao, aorta; LA, left atrium; LV, left ventricle. Dashed lines indicate the changes in LA and LV morphology obtained with operation. ( Reproduced from: Pelliccia F et al. Int J Cardiol. 2020;304:86–92,with permission) [••]
Fig. 2
Fig. 2
Coronary angiography during alcohol septal ablation. a Left coronary angiography shows the target septal branch (arrow). b Injection of contrast dye through the central lumen of the inflated balloon determines the supply area of the septal branch and excludes leak into the LAD. c Occluded septal branch (arrow) after balloon retraction 10 min after last alcohol injection without damage of the left anterior descending artery. ASA, alcohol septal ablation; LAD, left anterior descending. Arrows indicate the target septal branch. ( Reproduced from: Pelliccia F et al. Int J Cardiol. 2020;304:86–92,with permission) [••]
See this image and copyright information in PMC

References

Papers of particular interest, published recently, have been highlighted as:

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