Nonsurgical Reduction of the Interventricular Septum in Patients with Hypertrophic Cardiomyopathy

Some patients with hypertrophic cardiomyopathy and left ventricular outflow tract obstruction do not have a response to medical therapy with beta-blockers or calcium-channel blockers. Surgical myomectomy is sometimes recommended. These investigators report preliminary observations on nonsurgical reduction of the hypertrophied septum by the injection of alcohol into the septal perforator vessels, causing controlled infarction of the septum. Injection of alcohol can reduce outflow tract obstruction. Dynamic obstruction of the left ventricular outflow tract in patients with hypertrophic cardiomyopathy has been recognized for 40 years. 1 – 3 Despite advances in our understanding of its pathogenesis and diagnosis, the progressive nature of hypertrophic cardiomyopathy has not been remedied. Pharmacologic agents (beta-blockers, calcium-channel blockers, and disopyramide), 4 dual-chamber pacing, 5 – 7 and surgical myomectomy have all been used to treat hypertrophic cardiomyopathy. Both pacemaker implantation and surgical myomectomy provide hemodynamic and clinical benefits in patients with drug-resistant hypertrophic cardiomyopathy. 6 – 8 In the past decade, Knight et al. introduced a novel catheter-based nonsurgical technique 9 , 10 for the reduction of the left ventricular . . .