Acute and long-term results after transcoronary ablation of septal hypertrophy (TASH). Catheter interventional treatment for hypertrophic obstructive cardiomyopathy

Abstract

Transcoronary ablation of septal hypertrophy is a promising new treatment for hypertrophic obstructive cardiomyopathy in patients with severe symptoms. It should now be compared with alternative treatment strategies in prospective randomized studies.

Role of Transcoronary Ablation of Septal Hypertrophy in Patients With Hypertrophic Cardiomyopathy, New York Heart Association Functional Class III or IV, and Outflow Obstruction Only Under Provocable Conditions

“…25 Patients' self-perception of overall improvement was evaluated with a questionnaire that categorizes the subjective feeling of well-being as improved, unchanged, or deteriorated. 13 Echocardiography was performed on a Hewlett Packard Sonos 1500 ultrasound machine and recorded on S-VHS video to allow serial review and side-by-side comparison. Basal interventricular septum thickness was derived from an integrated analysis of M-mode and 2-dimensional echocardiograms.…”

“…13,14 A PTCA guiding catheter (6F to 7F), a guidewire (0.014 inch), and a PTCA balloon catheter (1.5 to 2.5/20 mm) were used for the catheterization of a small septal branch supplying the area of obstruction. The target vessel was identified by …”

“…A right ventricular stimulation catheter was inserted to facilitate reproducible measurement of the postextrasystolic gradient and to treat high-grade atrioventricular block that may develop during ethanol infusion. 13,16,24 Postprocedural management included a right ventricular stimulation catheter and continuous ECG monitoring in the coronary care unit for up to 4 days. Creatine phosphokinase activity was determined at hourly intervals during the first 24 hours.…”

“…Medical therapy with verapamil or ␤-blockers was continued during follow-up in the initial 50 patients but was individualized (to treat supraventricular arrhythmias) thereafter. 13 …”

“…[1][2]4,[7][8][9][10] In recent years, transcoronary ablation of septal hypertrophy (TASH) by selective transcatheter septal branch injection of ethanol has been shown to substantially reduce outflow obstruction in 80% to 90% and symptoms in 84% to 90% of patients. [11][12][13][14][15][16][17] Therefore, TASH may be an effective alternative to surgery. 18 -21 It remains a point of debate whether in patients with severe symptoms a provocable outflow gradient is sufficient to justify interventional therapy.…”