Objective: Alcohol septal ablation (ASA) has been shown to be an effective treatment in patients with hypertrophic obstructive cardiomyopathy (HOCM) who are refractory to medical treatment. We describe an alternative approach for septal ablation with glue (cyanoacrylate), which is particularly useful in patients with the collateral formation to the right coronary artery in whom ASA is contraindicated.
Methods: In our method left coronary ostium was cannulated with 6-8F guiding catheter. Septal branch was cannulated with a 4F catheter and a microcatheter then cyanoacrylate mixture was instilled into the septal artery. Immediate polymerization prevents the leak into the left anterior descending coronary artery, and also into the right coronary artery (RCA) via septal collaterals.
Results: Glue septal ablation (GSA) was performed in 18 patients (6 patients had collateral branches to RCA). Immediately after the procedure peak left ventricular outflow (LVOT) gradient reduced significantly both in cardiac catheterization (65.0 ± 13.8 vs. 14.2 ± 5.7 mmHg, P < 0.001) and Doppler echocardiographic measurements (75.8 ± 19.9 vs. 18.0 ± 9.1 mmHg, P < 0.001). LVOT tract gradient reduction persisted after 6 months follow-up. Septal wall thickness (20.2 ± 3.7 mm vs. 16.5 ± 3.2 mm, P = 0.003) reduced and NYHA functional class (3.1 ± 0.4 vs. 2.2 ± 0.3, P < 0.001) improved. There was no significant complication during the procedure and within 6 months follow-up period.
Conclusions: GSA seems to be an efficient and safe approach to HOCM, especially in patients with the collateral formation. Further experience is needed in order to assess the long-term efficacy and safety of this technique.
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