Non-surgical septal myocardial reduction by coil embolization for hypertrophic obstructive cardiomyopathy: early and 6 months follow-up

作者：Durand Eric; Mousseaux Elie; Coste Pierre; Pilliere Remy; Dubourg Olivier; Trinquart Ludovic; Chatellier Gilles; Hagege Albert; Desnos Michel; Lafont Antoine^*

来源：European Heart Journal, 2008, 29(3): 348-355.

DOI：10.1093/eurheartj/ehm632

• hypertrophic obstructive cardiomyopathy
• coil
• embolization
• alcohol
• complete heart block

Aims To evaluate the feasibility and the incidence of complete heart block (CHB) after non-surgical septal myocardial reduction by coil embolization in hypertrophic obstructive cardiomyopathy (HOCM).
Methods and results Twenty patients with HOCM and drug-refractory symptoms underwent non-surgical myocardial septal reduction by coil embolization with detachable coils. Occlusion of septal perforator branches was successfully performed in all patients. We detected neither ventricular tachycardia nor CHB. One patient presented an interventricular septal defect after the procedure, and died 19 days later. Cardiac magnetic resonance imaging showed, in all patients, an increase in areas of hyperenhancement in the interventricular septum (IVS) compared with baseline. At 6-month follow-up, NYHA functional class and peak oxygen consumption were significantly improved compared with baseline (14.8 +/- 4.5 vs. 18.5 +/- 4.5 mL/kg/min; P = 0.001, respectively). Echocardiography showed a significant reduction of the IVS thickness and left ventricular outflow tract gradient (21 +/- 3 vs. 17 +/- 4 mm, P < 0.0001; 80 +/- 29 to 35 +/- 29 mmHg, P < 0.0001, respectively).
Conclusion The results of this pilot non-randomized study suggest that non-surgical septal myocardial reduction by coil embolization in HOCM is feasible and does not induce CHB. Larger studies, ideally with a randomized comparison between coil embolization and alcohol septal ablation, are warranted.

• 出版日期2008-2
• 单位河南工业大学