Pericardium-covered stent for septal myocardial ablation in hypertrophic obstructive cardiomyopathy

Gaspar, Jorge; Martínez-Ríos, Marco Antonio; Vonderwalde, Carlos; Rosas, Martı́n; Ban‐Hayashi, Ernesto; Eidt‐Lidt, Guering; Kuri, J

doi:10.1002/(sici)1522-726x(199905)47:1<73::aid-ccd17>3.0.co;2-z

Cited by 19 publications

(16 citation statements)

References 12 publications

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“…Complications include heart failure, myocardial ischemia, myocardial infarction, infectious endocarditis, the formation of aneurysms and ruptures, and embolisms (7–10). Therefore, symptomatic or large-shunt CAF or CAF with coronary aneurysm should be treated as quickly as possible upon diagnosis (11–16). The conventional approach of ligating or suturing by opening the chest previously had an important role in CAF treatment (11,12).…”

Section: Discussionmentioning

confidence: 99%

“…Since Sigwart (17) treated idiopathic hypertrophic subaortic stenosis (IHSS) by percutaneous transcatheter septomyocardial ablation (PTSMA) with chemical agents in 1995, an increasing number of studies have been published regarding this technique, demonstrating satisfactory recent/mid-term outcomes and a promising future for its application (13–16,18–23). Although improvements have been made in terms of methodology, instrument quality, rate of success, mortality and degree of complication, there have been cases of severe complications, such as three branch heart block, complete atrioventricular block (19–23), pulmonary embolism (19), non-flow of the LAD artery, and ventricular fibrillation requiring conversion defibrillation (22).…”

Section: Discussionmentioning

confidence: 99%

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Percutaneous transluminal radiofrequency closure of the coronary artery in animal studies

Chenyun

Cai

et al. 2013

Experimental and Therapeutic Medicine

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The aim of this study was to investigate the safety and effectiveness of a novel method for the selective transcoronary closure of small coronary arteries by the intraluminal application of radiofrequency (RF) energy. Twenty-six small (diameter of 1–2 mm) coronary artery branches were selected in 13 dogs. An RF electrode wire (CRW-Zcy) was placed into the target vessel and a coronary balloon was used to transiently block the blood flow and limit damage to the proximal vessel. A therapeutic dosage of 20–30 W of RT energy every 10–30 sec (selected according the diameter of the target artery) was discharged via the CRW-Zcy inside a microcatheter two or three times in order to achieve arterial closure. A high dosage of 60 W every 120 sec of RF energy was used to conduct the safety study. All 26 branches were successfully closed resulting in the complete blockage of the antegrade and retrograde flows. The area of injury was limited to the target artery and the supplied myocardium. High-dose RF did not cause injury to the adjacent vessels and myocardium. The animals tolerated the procedure well without any untoward systemic effects. A follow-up angiography at two weeks revealed no evidence of recanalization or retrograde filling of the target artery. Percutaneous transluminal radiofrequency closure is a safe and effective interventional approach for closing the small coronary arteries, and is potentially valuable for further investigation.

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Section: Discussionmentioning

confidence: 99%

Section: Discussionmentioning

confidence: 99%

Percutaneous transluminal radiofrequency closure of the coronary artery in animal studies

Chenyun

Cai

et al. 2013

Experimental and Therapeutic Medicine

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“…During the past few years, technological revolutions in nonsurgical treatment have allowed the exploration of new therapeutic options for patients with HOCM. In methods similar to PTSMA, covered stents or microcoils have been used to induce necrosis of the basal septum by selective occlusion of the perforated septal artery irrigating the hypertrophic area [15–18]. Unlike PTSMA, these therapeutic strategies prevent alcohol from flowing into remote myocardium and producing unexpected lesions.…”

Section: Discussionmentioning

confidence: 99%

A new strategy for septal ablation with transendocardial ethanol injection using a multifunctional intracardiac echocardiography catheter: A feasibility study in canines

Guo

Qian

Yang

et al. 2011

Cathet Cardio Intervent

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“…Vereinzelt finden sich Versuche, bei denen statt absolutem Alkohol eine Septalastokklusion durch Embolisation, d. h. durch Injektion von Polyvenylalkoholschaum Partikeln (41) oder mittels Perikard beschichtetem stent vorgenommen wurde (9).…”

Section: Technikunclassified

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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Pericardium-covered stent for septal myocardial ablation in hypertrophic obstructive cardiomyopathy

Cited by 19 publications

References 12 publications

Percutaneous transluminal radiofrequency closure of the coronary artery in animal studies

Percutaneous transluminal radiofrequency closure of the coronary artery in animal studies

A new strategy for septal ablation with transendocardial ethanol injection using a multifunctional intracardiac echocardiography catheter: A feasibility study in canines

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

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