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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