Iatrogenic Deaths Following Treatment for Hypertrophic Obstructive Cardiomyopathy

Batalis, Nick I.; Harley, Russell A.; Collins, Kim

doi:10.1097/01.paf.0000188096.28402.c9

Cited by 11 publications

(5 citation statements)

References 21 publications

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“…It has been reported that infarcts in the anterior wall of the left ventricle have occurred due to septal ablation therapy (Ruzyllo et al, 2000;Chowdhary et al, 2007), however the frequency of occurrence is not known due to under-reporting of such complications (Batalis et al, 2005). Our study reports that the frequency of DSP termination in the left ventricular anterior wall was 5%.…”

Section: Discussionmentioning

confidence: 64%

Descriptive anatomy of the dominant septal perforators using Dual Source coronary CT angiography

et al. 2009

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Although clinical outcomes for septal ablation in treating left ventricular outflow tract obstructions are generally favorable, a variety of complications have been reported including a high incidence of right bundle branch block. These complications may be attributed to anatomic variability of the dominant septal perforator. We used Dual Source CT Coronary Angiography (DS-CTA) to determine the location of the termination point of the dominant septal perforator as well as the distance of the termination point from the mitral annulus in patients undergoing DS-CTA. One-hundred-fourteen DS-CTA scans were retrospectively reviewed by two observers by consensus. The left ventricle was divided into anterior wall, anterioseptum, and inferioseptum. For each segment, the myocardium was divided into three layers (1) right ventricular side, (2) mid portion, and (3) left ventricular side. The zone of termination of the dominant septal perforator was identified as well as the distance of the termination point from the mitral annulus. The dominant septal perforator terminated in the right ventricular side of the anterioseptum in 86 of the 118 visualized terminations (73%) and in the left ventricular anterior wall in 6 visualized terminations (5%). On average, the dominant septal perforator terminated 26.3 +/- 8.6 mm from the mitral annulus. In the majority of cases, the dominant septal perforator terminates in the right ventricular side of anterioseptum. In addition, there is great variability in the distribution of the termination point of the dominant septal perforator from the mitral annulus.

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Section: Discussionmentioning

confidence: 64%

Descriptive anatomy of the dominant septal perforators using Dual Source coronary CT angiography

et al. 2009

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“…Only in a minority of cases (23.6%-category A) is an accurate cause of death determinable with minimal clinical history. This need for detailed clinico-pathological correlation in iatrogenic deaths is also highlighted by the works of several authors, who emphasize the importance of a trustful relationship among the various healthcare providers and the pathologists in the prevention of medical errors and adverse events and a comprehensive clinico-pathological discussion being an essential element for medical auditing and teaching as despite significant progress in diagnostic procedures, autopsy has not always confirmed the clinical diagnosis [7,10,18,19]. We also find that as the number of days of survival between injury and death increases, the greater the need for detailed clinical documentation to ascertain the cause of death.…”

Section: Discussionmentioning

confidence: 96%

When is a peri-procedural death iatrogenic in nature?

Wang

Lau

2011

Forensic Sci Med Pathol

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In almost any instance of suspected iatrogenic fatality, the attending forensic pathologist faces the challenging and often daunting task in ascertaining the cause of death, determining if an iatrogenic injury had indeed occurred and if so, its contribution to the causation of death. The Forensic Medicine Division of the Health Sciences Authority in Singapore embarked on a 6 year study of such deaths to identify pertinent factors that may facilitate the assessment of iatrogenic injuries and their contribution to mortality. A total of 106 iatrogenic deaths, arising from 613 coroner's peri-procedural autopsies conducted during the period of 2005-2010 were reviewed with particular reference to the following parameters: (1) clinico-pathological correlation; (2) the length of survival; (3) the number of interventional procedures. A comprehensive analysis of these cases indicated that they could be classified into the following 3 categories, in relation to the role of clinico-pathological correlation in the ascertainment of the causes of death: (A) advantageous but not essential; (B) essential; (C) critical. A large proportion of the cases (76.5%) were assigned categories B and C. Only the minority of cases (23.6%) were assigned category A. Also, as the number of days of survival between injury and death, and the number of interventional procedures after injury increases, the greater the need for detailed clinical documentation to ascertain the cause of death.

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“…6) [62,63], which represents a potentially unstable arrhythmogenic substrate which has triggered potentially lethal ventricular tachyarrhythmias in about 10% of ablation patients and raises SD risk in some susceptible individuals [14,[51][52][53][54][55][56][57][58][59][60][61][62][63][64][65]. This recognized risk for sustained ventricular tachyarrhythmias occurs largely over the short term [14,[51][52][53][54][55][56][57][58][59][60][61][62][63][64][65] with reported postprocedural annual event rates of 3% to 5% (Table 2) [64,65]. Based on this consideration, some practitioners have prudently implanted ICDs prophylactically in selected patients following alcohol septal ablation [65].…”

Section: Alcohol Septal Ablationmentioning

confidence: 97%

“…SD risk factors for the selection of HCM patients for primary prevention ICDs BP blood pressure, CMR cardiovascular magnetic resonance, EF ejection fraction, LV left ventricular, LVH left ventricular hypertrophy, NSVT nonsustained ventricular tachycardia, SD sudden death a Gradient ≥50 mmHg at rest b Sustained ventricular tachyarrhythmias have been reported in a significant minority of patients in the short-term following the alcohol septal ablation procedure[14,[51][52][53][54][55][56][57][58][59][60][61][62][63][64][65] c Wall thickness, ≥30 mm by echocardiography d ≥3 beats at ≥120/min…”

mentioning

confidence: 99%

Sudden Death in Hypertrophic Cardiomyopathy

Maron

2009

J. of Cardiovasc. Trans. Res.

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Hypertrophic cardiomyopathy (HCM) is regarded as the most common cause of sudden cardiac death in young people (including trained athletes). However, assessing sudden death (SD) risk and identifying the most appropriate candidates for prophylactic device therapy is a complex process compounded by the unpredictability of the underlying arrhythmogenic substrate, absence of a single dominant and quantitative risk maker for this heterogeneous disease, and also the difficulty encountered in assembling sufficiently powered prospective and randomized trials in large patient populations. Patients with multiple risk factors and most young patients with one strong and unequivocal risk marker can be considered candidates for primary prevention defibrillators. Despite certain limitations, the current risk factor algorithm (when combined with a measure of individual physician judgment) has proved to be an effective strategy for targeting high-risk status. This approach has served the HCM patient population well, as evidenced by the significant appropriate defibrillator intervention rates, although a very small proportion of patients without conventional risk factors may also be at risk for SD. Indeed, the introduction of implantable defibrillators to the HCM patient population represents a new paradigm for clinical practice, offering the only proven protection against SD by virtue of effectively terminating ventricular tachycardia/fibrillation. In the process, implantable defibrillators have altered the natural history of HCM, potentially providing the opportunity of normal or near-normal longevity for many patients. Prevention of SD is now an integral, albeit challenging, component of HCM management.

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Iatrogenic Deaths Following Treatment for Hypertrophic Obstructive Cardiomyopathy

Cited by 11 publications

References 21 publications

Descriptive anatomy of the dominant septal perforators using Dual Source coronary CT angiography

Descriptive anatomy of the dominant septal perforators using Dual Source coronary CT angiography

When is a peri-procedural death iatrogenic in nature?

Sudden Death in Hypertrophic Cardiomyopathy

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