Percutaneous transcoronary septal myocardial ablation (PTSMA) in hypertrophic cardiomyopathy: results of long-term follow up
█ Original article
Szűcsborus Tamás>1, Pálinkás Attila2, Nagy Viktória1, Pálinkás Eszter1, Ungi Imre1, Hubert Seggewiss3, Sepp Róbert1
1Szegedi Tudományegyetem, II. sz. Belgyógyászati Klinika és Kardiológiai Központ, Szeged
2Erzsébet Kórház, Belgyógyászati Osztály, Hódmezővásárhely
3Medizinische Klinik 1, Leopoldina-Krankenhaus, Schweinfurt, Németország
Background: Percutaneous transcoronary septal myocardium ablation (PTSMA) is a catheter-based method to relieve the left ventricular outflow tract (LVOT) obstruction in hypertrophic cardiomyopathy (HCM).
Aims: We aimed to analyze the long-term follow-up data of our patients underwent PTSMA at our Department.
Patients and methods: Between March 2005 and December 2017 contrast echocardiography guided PTSMA was performed in 55 patients. In 23 cases, PTSMA was given up due to abnormal collaterals perfusing non-target myocardial areas. In the 32 completed cases (19 females, 13 males, average age 51±14 yrs) follow up with complete cardiology assessment was performed at 3 and 12 months.
Results: No patient had death, major arrhythmia, newly developed AV or bundle branch block, requiring permanent pace-maker implantation during the procedures or follow-up. NYHA status of the patients was significantly improved both at 3-month (P<0.0001), and one-year follow up (P=0.0008). The resting peak LVOT gradient decreased significantly both at 3-month FU (80±33 vs. 40±46 mmHg, P=0.0099) and at one-year FU (75±38 vs. 37±31 mmHg, P=0.039). The provoked gradient was also substantially decreased (at 3-month FU: 124±44 vs. 57±55 mmHg, P=0.0016; at 12-month FU: 136±45 vs. 81±61 mmHg P=0.0469). All the patients were alive during the average 5±3 years-long follow up.
Conclusion: Percutaneous transluminal septal myocardium ablation is a powerful method to decrease left ventricular outflow tract obstruction in hypertrophic cardiomyopathy. The procedure is effective also on the long term and subsequently leads to improvement of symptoms and exercise capacity of the patients.