Induced Septal Infarction/Nonsurgical Septal Reduction for  Hypertrophic Obstructive Cardiomyopathy

Kuhn, H.

doi:10.1161/01.cir.97.7.709

Cited by 7 publications

(3 citation statements)

References 5 publications

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“…Percutaneous transluminal septal myocardial ablation (PTSMA) for hypertrophic obstructive cardiomyopathy was first performed in 1994 29,30 . The procedure involves creating a limited MI in the offending subaortic ventricular septum, by injecting alcohol directly into a septal perforating vessel.…”

Section: Percutaneous Transluminal Septal Myocardial Ablationmentioning

confidence: 99%

“…Debate is ongoing regarding the appropriate role of PTSMA. Worldwide, at least 1000 patients have already undergone the procedure 30,42 . Concern has been raised that, whereas the eligibility criteria for PTSMA and surgical myectomy−myotomy are identical, the number of patients who have undergone percutaneous alcohol ablation is 10 times that which would have been expected if surgery were the only option.…”

Section: Current Role Of Percutaneous Transluminal Septal Myocardial mentioning

confidence: 99%

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Hypertrophic cardiomyopathy: state‐of‐the‐art review, with focus on the management of outflow obstruction

Kovacic

Müller

2003

Internal Medicine Journal

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Significant advances in our understanding and management of hypertrophic cardiomyopathy have been made in the last decade, as the complex genetics and phenotype-genotype correlations that characterize the disease are gradually unravelled. The well-described clinical heterogeneity of hypertrophic cardiomyopathy is now understood to be based on profound genetic variability, with at least 10 genes and over 150 mutations implicated. Several new therapeutic tools have entered clinical practice. The implantable cardioverter-defibrillator is now strongly indicated in those at high risk of sudden arrhythmic death. Our ability to abort sudden death in this subgroup has placed added emphasis on risk stratification in newly diagnosed patients. New procedures have also been developed for the relief of outflow obstruction in patients with refractory symptoms and a significant subaortic outflow gradient. Although not as efficacious as the 'gold-standard' surgical myectomy-myotomy, dual-chamber pacemaker implantation can be of modest benefit in select patients. Percutaneous transluminal septal myocardial ablation is an emerging catheter-based procedure for the relief of left ventricular outflow obstruction. Long-term follow-up data are still awaited. However, intermediate-term results suggest equivalent efficacy to surgical myectomy-myotomy.

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Section: Percutaneous Transluminal Septal Myocardial Ablationmentioning

confidence: 99%

Section: Current Role Of Percutaneous Transluminal Septal Myocardial mentioning

confidence: 99%

Hypertrophic cardiomyopathy: state‐of‐the‐art review, with focus on the management of outflow obstruction

Kovacic

Müller

2003

Internal Medicine Journal

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“…Sie führten zu dem Vorschlag der therapeutischen Injektion von absolutem Alkohol in den ersten größeren Ast des Ramus interventricularis anterior nach vorausgehender Ballonokklusion des Septalastes (10,(18)(19)(20). 1995 erfolgte dies erstmals durch Sigwart (38) und danach im gleichen Jahr -bei anders selektionierten Patienten -durch die eigene Arbeitsgruppe (11,(18)(19)(20)(21). Die ersten therapeutischen Anwendungen jähren sich also zum fünften Mal.…”

Section: Abstract Tash -Hypertrophic Obstructive Cardiomyopathyalcohunclassified

Fünf Jahre TASH (Transkoronare Ablation der Septum Hypertrophie), eine Bilanz

Kuhn¹

2000

Z Kardiol

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From 1991 to 1993, our group carried out extensive studies in the development of a new catheter-interventional concept of treatment for HOCM and suggested in 1994 the injection of absolute ethanol into the first major septal branch using the common PTCA technique. This approach was first used therapeutically by Sigwart in London and by our group in Bielefeld. Based on rhythmologic studies of other authors we suggested the designation Transcoronary Ablation of Septal Hypertrophy (TASH). Since 1995, an estimated 1000 patients (about 600 from Germany) in some 20 countries have been treated by this method. In 1997 a national multicenter TASH-registry was created by the German Cardiac Society. During the last five years extensive studies have been performed by different groups. Significant clinical and hemodynamic improvements were consistently found. This was true for both young and old patients, for patients with resting gradient and with provocable gradient. Clinical improvement (rate of improved patients about 90%) was seen under conditions of rest and stress, as well as during long-term follow-up. Specifically, there was a significant decrease of functional class, a reduced rate of syncope, and a reduced degree of mitral insufficiency. Exercise capacity, oxygen uptake and the cardiac index increased, intraventricular gradient, the end diastolic pressure of the left ventricle and the left atrial size decreased. Also there was a decrease in the septal thickness with increase in the cross sectional area of the outflow tract and with local contraction disorder. PET examination showed an ablation induced local myocardial defect. There was also evidence for improved diastolic function. Electrophysiological and Holter monitor studies indicated no increased arrhythmogenicity. The prognosis seems to be improved. Histologically, an atypical infarct pattern was found, i.e., the common round cell infiltration and the fibrotic process were surrounding but not penetrating the alcohol induced myocardial center of necrosis. The in-hospital mortality rate amounts to about 1.8%. The rate of permanent total av-block after TASH is less than 10%. In 15% a second TASH is necessary. In summary, during the last five years TASH has become a promising new catheter interventional therapy for HOCM, which compares favorably with surgical treatment. In experienced centers it has become a routinely performed procedure. The indication should be limited to severely symptomatic patients with typical (subaortic) HOCM. Further careful clinical examinations after TASH are required. All patients should be enrolled into a registry. TASH also constitutes a new area for comprehensive clinical research.

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Transcoronary ablation of septal hypertrophy (TASH): a new treatment option for hypertrophic obstructive cardiomyopathy

Kuhn¹,

Gietzen²,

Leuner³

et al. 2000

Zeitschrift f�r Kardiologie

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In 1991, our group started to develop a catheter interventional therapy for hypertrophic obstructive cardiomyopathy (HOCM). The new concept was proposed in 1994. It is based on the conventional PTCA technique with the aim of inducing an artificial myocardial infarction by instillation of 96% ethanol into the most proximally situated septal branch of the left anterior descending coronary artery. This leads to a subaortic contraction disorder with subsequent decrease of the intraventricular pressure gradient, shrinkage of the hypertrophied septal bulge and widening of the outflow tract ("therapeutic remodeling"). The subaortic defect is small and well demarcated as assessed by left ventricular angiography, transesophageal echocardiography and 18 F-glucose positron emission tomography. The term transcoronary ablation of septum hypertrophy (TASH) was suggested. Our patient cohort that now comprises 215 therapeutic procedures in 187 patients underwent a large variety of prospective studies (maximum follow-up 4.5 years) including invasive controls at regular intervals, investigation of hemodynamics at rest and at exercise, transesophageal and transthoracic echocardiography, Doppler echocardiography during bicycle exercise, electrophysiologic testing, Holter monitoring and measurement of myocardial metabolism and perfusion, assessment of microembolic events by transcranial Doppler sonography and histological examinations. This article gives an overview and reports our increasing experience in applying TASH. The following post-TASH findings were obtained: significant hemodynamic and clinical improvement at rest and at exercise, decrease of septum thickness, increase of outflow tract area and decrease of induced ventricular tachycardia. There were well-demarcated, histologically atypical subaortic myocardial defects, no microembolic events, abnormal early peak of infarct related enzymes, and no change of baroreflex sensitivity. Pre-/post-TASH evaluations of the patients should be based in particular on clinical symptoms correlated to the intraventricular gradient measured by bicycle exercise Doppler echocardiography and to outflow tract area as assessed by transesophageal echocardiography. Since 1994, as a roughly estimate, worldwide 1000 patients in 20 countries have been treated. According to published articles, abstract presentations and workshops, TASH consistently leads to a pronounced clinical and hemodynamic benefit for patients with HOCM. TASH has become an established technique. At least in centers with a high level of expertise, it is no longer experimental but a routinely performed alternative to surgical treatment for HOCM, i.e., the previous gold standard of therapy. Of course, patient outcome needs further careful clinical and prognostic evaluation. With respect to complications, TASH appears to be superior to surgery (transaortic septal myectomy) for HOCM. Like surgical treatment, TASH is currently indicated in critically ill patients with typical HOCM (subaortic form), who exhibit with drug refractory symp...

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Induced Septal Infarction/Nonsurgical Septal Reduction for Hypertrophic Obstructive Cardiomyopathy

Cited by 7 publications

References 5 publications

Hypertrophic cardiomyopathy: state‐of‐the‐art review, with focus on the management of outflow obstruction

Hypertrophic cardiomyopathy: state‐of‐the‐art review, with focus on the management of outflow obstruction

Fünf Jahre TASH (Transkoronare Ablation der Septum Hypertrophie), eine Bilanz

Transcoronary ablation of septal hypertrophy (TASH): a new treatment option for hypertrophic obstructive cardiomyopathy

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