Alcohol Septal Ablation for Hypertrophic Obstructive ...

[Pages:77]SOLACI 2014 San Juan, Puerto Rico

Alcohol Septal Ablation for Hypertrophic Obstructive Cardiomyopathy

Igor F. Palacios, MD Director, Interventional Cardiology Massachusetts General Hospital Professor of Medicine Harvard Medical School

Gross pathology

LA AoV

MV PW IVS

Anatomic phenotypes

? HOCM ("IHSS") ? ASH without obstruction ? Midventricular obstruction ? Apical ? Free wall ? Concentric

Hemodynamic classification

? HOCM

? Resting obstruction (30 mmHg) ? Provocable obstruction

? Valsalva manuever ? Amy nitrite ? Exercise

Valsalva maneuver

LV

Ao

Hemodynamic classification

? HOCM

? Resting obstruction (30 mmHg) ? Provocable obstruction

? HNOCM

? But dynamic, with marked variability

Corollary: management decisions are based on degree of symptoms, not magnitude of gradient

Spontaneous variation in gradient

LV Ao

Management

? Restrict activity ? Screen relatives ? Prevent sudden death ? Control symptoms

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