Hypertrophic obstructive cardiomyopathy: a comparison of treatment options

Claire Braybrook

This article has no abstract so we have provided the first paragraph of the full text.

Asymmetrical septal hypertrophy that causes a left-ventricular outflow tract (LVOT) gradient is a common feature of hypertrophic obstructive cardiomyopathy (HCOM). Septal myectomy is the standard treatment for patients with this condition, although percutaneous transluminal septal myocardial ablation (PTSMA) is a nonsurgical alternative that involves injecting alcohol into a septal branch of the left anterior descending artery, causing local ischemia and myocardial infarction. Both of these techniques are effective methods to reduce septal thickness and thus LVOT gradients in patients with HCOM. After septal myectomy, there is an immediate decrease in LVOT gradient, whereas the gradient reduction following PTSMA is biphasic and more gradual. Mitral-valve defects are frequently associated with HCOM and can be corrected using a technique called mitral-leaflet extension (MLE). Sustained hemodynamic improvements have been reported in patients treated using a combination of MLE and septal myectomy.

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