Septal hypertrophy

Subvalvular myectomy has a reported success of more than 90% with a mortality rate of less than 2%, but this therapy is not applicable to every patient. Transcatheter ablation of septal hypertrophy has been performed since 1994 as a reasonable option for obstructive HCM patients. An increasing number of reports claim efficacy comparable to that of the surgical approach (3). 

Gietzen FH, Leuner CJ, Obergassel L, et al. Role of transcoronary ablation of septal hypertrophy in patients with hypertrophic cardiomyopathy, New York Heart Association functional class III or IV and outflow obstruction only under provocable conditions. Circulation 2002 106 454-459. 

Kim JJ, Lee CW, Park SW, et al. Improvement in exercise capacity and exercise blood pressure response after transcoronary alcohol ablation therapy of septal hypertrophy in hypertrophic cardiomyopathy, Am J Cardiol 1999 83(8) 1220-1223. 

Gietzen FH, Leuner CJ, Raute-Kreinsen U, et al. Acute and long-term results after transcoronary ablation of septal hypertrophy (TASH), Catheter interventional treatment for hypertrophic obstructive cardiomyopathy. Eur Heart J 1999 20(1 8) 1342-1354. 

Patients with the non-obstructive form of hypetrophic cardiomyopathy should not undergo septal ablation. Patients with congential anomalies of the mitral valve apparatus, associated heart lesions (e.g., advanced multivessel coronary artery disease) requiring surgical correction, unfavorable distribution of septal hypertrophy with mild proximal thickening, basal septal wall thickness < 18 mm, or anatomically unsuitable septal perforators should not be candidates for septal ablation. 

Raute-Kreinsen U. Morphology of necrosis and repair after transcoronary ethanol ablation of septal hypertrophy. Pathol Res Pract 2003 199 121-127. 

Right ventricle hypertrophy (negative T wave in V1) or septal hypertrophy as in hypertrophic cardiomyopathy. 

Echocardiogram LV dilatation and dysfunction Asymmetric septal hypertrophy Systolic anterior motion of the mitral valve Increased LV wall thickness possible... 

The hypertrophy seen in HCM usually is diffuse and involves the septum and LV anterolateral free wall to a greater degree than the posterior segment. Asymmetric septal hypertrophy is a sensitive marker for HCM but is not specific for this disorder. In patients with outflow obstruction, the basal septum usually is markedly thickened at the level of the mitral valve. In patients with nonobstructive HCM, the outflow tract is larger, and the septal hypertrophy that occurs has a more distal or apical distribution. 

Mazur W, Nagueh SF Lakkis NM, et al. Regression of left ventricular hypertrophy after nonsurgical septal reduction therapy for hypertrophic obstructive cardiomyopathy. Circulation 2001 103 1492-1496. 

Rat 140 Whole body 0.4,1.0, 2.5 6 h/d, 5 d/wk or 3 alternate d/ wk for 2yr Lesions in nasal passages of all animals (mainly the anterior nasal cavity) included respiratory and olfactory epithelial degeneration, septal fenestration, mucosa inflammation, respiratory epithelial hyperplasia, squamous metaplasia, goblet cel hypertrophy and hyperplasia, secretory metaplasia of the transitional epithelium of the lateral meatus. Severity of the lesions was concentration related. LOAEL 0.4 Wolfetal. 1995... 

FIGURE 8.4 MRI of a representative patient with pulmonary arterial hypertension showing (A) right ventriculation dilation, right ventricular hypertrophy, septal flattening (B) mid-myocardial scar (C) normal AO/PA flow without evidence of shunt. 

---