Percutaneous transluminal septal artery ablation using polyvinyl alcohol foam particles for septal hypertrophy in patients with hypertrophic obstructive cardiomyopathy: acute and 3-year outcomes.

摘要

Purpose: To investigate the effect of septal artery occlusion with transluminally delivered polyvinyl alcohol (PVA) foam particles for the treatment of hypertrophic obstructive cardiomyopathy (HOCM).Methods: Percutaneous septal artery ablation was performed in 18 symptomatic patients (13 men; mean age 60+/-17 years, range 28-89) with drug-resistant HOCM. PVA foam particles were mixed with contrast medium and injected through an angiographic catheter under fluoroscopic control until complete stasis in the septal branch was achieved. Patients were monitored with echocardiography and cardiovascular magnetic resonance imaging.Results: The septal artery was successfully occluded in all patients; no embolization of other coronary branches occurred after infusion of 3 to 8 mL (5.2+/-0.8) of PVA foam particles. The resting pressure gradient was diminished from 83+/-32 to 31+/-35 mmHg (p<0.05). Over a mean follow-up of 44+/-4 months, all patients had symptomatic improvement of their dyspnea and workload withoutthe need for intensified drug therapy. The average NYHA functional class decreased from 3.3+/-0.5 to 1.3+/-0.7 (p<0.0001), with a significant increase in the area of the left ventricular outflow tract (1.3+/-0.2 to 2.6+/-0.2 cm(2), p<0.0001). Three instances of transient atrioventricular block occurred, but no complete heart block was produced by the embolization procedure.Conclusions: Embolization of the septal artery with PVA foam particles appears effective and safe in this series of patients with hypertrophic obstructive cardiomyopathy. The pure ischemic infarction produced by PVA ablation might be the responsible for the lack of complete heart block and the need for permanent pacing.