Alcohol septal ablation in patients with concomitant hypertrophic cardiomyopathy and aortic valvular stenosis

Bassim El-Sabawi, Rick A. Nishimura, Mayra Guerrero, Charanjit Rihal, Mackram Eleid

Research output: Contribution to journalArticle

Abstract

Objective: To describe the hemodynamic and early clinical outcomes of percutaneous alcohol septal ablation in patients with concomitant dynamic left ventricular outflow tract (LVOT) obstruction and aortic valvular stenosis (AS). Background: Alcohol septal ablation is an established method to relieve dynamic LVOT obstruction in patients with hypertrophic cardiomyopathy (HCM). However, the feasibility, safety, and efficacy of alcohol septal ablation in patients with serial obstructions from HCM and AS remain unclear. Methods: In this case series, we describe the early outcomes of alcohol septal ablation in six patients with significant dynamic LVOT obstruction and AS. All patients had evidence of severe dynamic LVOT obstruction (resting or provoked gradient ≥50 mmHg), mild to severe AS, and NYHA class III symptoms or greater. Results: Four (66.7%) patients had septal ablation performed in the setting of concomitant native valvular AS and two (33.3%) patients had TAVR performed prior to septal ablation. Successful alcohol septal ablation was performed in all patients and was associated with an immediate reduction of the dynamic LVOT gradient with a residual fixed obstruction related to AS. Four (66.7%) patients had follow-up at 1 month and of these, three (75%) had NYHA Class I–II symptoms and one (25%) Class III. Conclusions: Alcohol septal ablation is a feasible method of relieving dynamic LVOT obstruction in patients with concomitant HCM and AS. Further study is required to determine the optimal treatment approach in these patients.

Original languageEnglish (US)
JournalCatheterization and Cardiovascular Interventions
DOIs
StateAccepted/In press - Jan 1 2019

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Hypertrophic Cardiomyopathy
Aortic Valve Stenosis
Alcohols
Ventricular Outflow Obstruction
Hemodynamics
Safety

Keywords

  • aortic valve disease
  • hemodynamics
  • percutaneous intervention
  • transcatheter valve implantation

ASJC Scopus subject areas

  • Radiology Nuclear Medicine and imaging
  • Cardiology and Cardiovascular Medicine

Cite this

Alcohol septal ablation in patients with concomitant hypertrophic cardiomyopathy and aortic valvular stenosis. / El-Sabawi, Bassim; Nishimura, Rick A.; Guerrero, Mayra; Rihal, Charanjit; Eleid, Mackram.

In: Catheterization and Cardiovascular Interventions, 01.01.2019.

Research output: Contribution to journalArticle

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abstract = "Objective: To describe the hemodynamic and early clinical outcomes of percutaneous alcohol septal ablation in patients with concomitant dynamic left ventricular outflow tract (LVOT) obstruction and aortic valvular stenosis (AS). Background: Alcohol septal ablation is an established method to relieve dynamic LVOT obstruction in patients with hypertrophic cardiomyopathy (HCM). However, the feasibility, safety, and efficacy of alcohol septal ablation in patients with serial obstructions from HCM and AS remain unclear. Methods: In this case series, we describe the early outcomes of alcohol septal ablation in six patients with significant dynamic LVOT obstruction and AS. All patients had evidence of severe dynamic LVOT obstruction (resting or provoked gradient ≥50 mmHg), mild to severe AS, and NYHA class III symptoms or greater. Results: Four (66.7{\%}) patients had septal ablation performed in the setting of concomitant native valvular AS and two (33.3{\%}) patients had TAVR performed prior to septal ablation. Successful alcohol septal ablation was performed in all patients and was associated with an immediate reduction of the dynamic LVOT gradient with a residual fixed obstruction related to AS. Four (66.7{\%}) patients had follow-up at 1 month and of these, three (75{\%}) had NYHA Class I–II symptoms and one (25{\%}) Class III. Conclusions: Alcohol septal ablation is a feasible method of relieving dynamic LVOT obstruction in patients with concomitant HCM and AS. Further study is required to determine the optimal treatment approach in these patients.",
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