Interventional Treatments for Hypertrophic Cardiomyopathy

Abstract

SUMMARYHypertrophic cardiomyopathy (HCM) is the most common inherited cardiac disorder. This autosomal dominant condition is defined by left ventricular hypertrophy and associated with functional limitation and premature death. In fact, many individuals are asymptomatic and the annual mortality in most modern series is 1% or less. However, severe symptoms may develop at any age, and the risk of premature death from arrhythmia, stroke, and progressive systolic impairment may complicate asymptomatic disease. The clinical management of patients with HCM therefore encompasses (1) genetic counseling including discussion of indications for genetic testing and cascade family screening, (2) assessment of prognostic risk from ventricular arrhythmia, stroke, and heart failure, and (3) symptom management. This article describes the interventional treatments in the management of severe symptoms associated with left ventricular outflow tract obstruction (LVOTO).

Doppler echocardiography underestimates the prevalence and magnitude of mid‐cavity obstruction in patients with symptomatic hypertrophic cardiomyopathy

“…Therefore, for a subset of symptomatic patients with suspected LVMCO we consider invasive gradient measurement. The IS protocol is preceded by coronary angiogram, allowing the operator to rule out concomitant coronary disease whilst defining the septal perforator branches that may be a suitable target for invasive therapy . The safety profile of isoprenaline use in HCM is informed of an absence of reported complications in the literature , a finding similar to our experiences.…”

“…Therefore, for a subset of symptomatic patients with suspected LVMCO we consider invasive gradient measurement. The IS protocol is preceded by coronary angiogram, allowing the operator to rule out concomitant coronary disease whilst defining the septal perforator branches that may be a suitable target for invasive therapy [16,17].…”

Tratamentul conservativ versus chicurgical al cardiomiopatiei hipertrofice

“…No 151 puțin invazivă. Momentele principale ale acestei tehnici sunt următoarele: identificarea unei artere septale perforante, izolarea acesteia de restul circulației coronariene și injectarea in artera respectivă a alcoolului [12].…”