Evaluation of left ventricular outflow tract area after septal reduction in obstructive hypertrophic cardiomyopathy: a real-time 3-dimensional echocardiographic study.

BACKGROUND: The comparative impact of percutaneous alcohol septal reduction (ASR) and surgical myectomy on the left ventricular outflow tract (LVOT) area in patients with obstructive hypertrophic cardiomyopathy (HC) is not well defined. Real-time 3-dimensional echocardiography (RT3DE) provides accurate information about the LVOT geometry and shape. We aimed to analyze the change in LVOT area after septal reduction interventions in patients with obstructive HC using RT3DE. METHODS: Thirty-one HC patients (mean age 53 +/- 17 years) undergoing ASR (n = 14) or myectomy (n = 17) were studied at baseline and during follow-up with RT3DE. LVOT area was measured after observing the LVOT in the 3D space as the smallest area during midsystole. LVOT pressure gradients were determined by conventional continuous wave Doppler. RESULTS: Overall, LVOT area increased from 0.86 +/- 0.20 to 2.50 +/- 0.88 cm2 (P < .01), and the resting LVOT pressure gradient decreased from 64 +/- 41 to 16 +/- 10 mm Hg (P < .01) after a median follow-up of 3 months after intervention (range 1-24 months). A similar significant decrease in LVOT pressure gradients was seen in myectomy and ASR groups (from 62 +/- 39 to 12 +/- 5 mm Hg and from 67 +/- 43 to 21 +/- 14 mm Hg, respectively, P < .01 in between each group, and P = NS between both groups). However, the increase in LVOT area was greater in myectomy than in ASR group (from 0.81 +/- 0.22 to 2.90 +/- 0.64 cm2 and 0.93 +/- to 0.16 to 2.02 +/- 0.92 cm2, respectively, P < .01 between both groups). CONCLUSION: RT3DE demonstrated an effective increase in LVOT area after both ASR and myectomy. This technique may be useful for assessing the results of septal reduction in patients with obstructive HC.

Comparison of left ventricular diastolic function in obstructive hypertrophic cardiomyopathy in patients undergoing percutaneous septal alcohol ablation versus surgical myotomy/myectomy.

Both percutaneous transcoronary alcohol septal reduction (ASR) and surgical myectomy are effective treatments to relieve left ventricular (LV) outflow tract obstruction in obstructive hypertrophic cardiomyopathy (HC). LV diastolic function was assessed by echocardiography in 57 patients with obstructive HC at baseline and 5 +/- 4 months after ASR (n = 37) or surgical myectomy (n = 20). LV outflow tract pressure gradient decreased from 65 +/- 40 to 23 +/- 21 mm Hg (p <0.01) after treatment. The ratio of the early-to-late peak diastolic LV inflow velocities, and the ratio of the early peak diastolic LV inflow velocity to the lateral mitral annulus early diastolic velocity determined by tissue Doppler imaging significantly decreased after the procedures (1.6 +/- 1.7 vs 1.0 +/- 0.7 and 15 +/- 8 vs 11 +/- 5, respectively), whereas LV inflow propagation velocity significantly increased (60 +/- 24 vs 71 +/- 36 cm/s). Left atrial size decreased from 29 +/- 7 to 25 +/- 6 cm(2) (p <0.05). Patients had a significant improvement in New York Heart Association functional class and in exercise performance. When comparing ASR with myectomy, no difference was found in the degree of change in any parameter of diastolic function. Thus, diastolic function indexes obtained by echocardiography changed after septal reduction interventions in patients with obstructive HC; this change was similar to that after surgical myectomy and ASR.