Alcohol septal ablation vs. surgical myectomy in the treatment of hypertrophic obstructive cardiomyopathy
Abstract
Hypertrophic cardiomyopathy is an autosomal dominant disease with prevalence of 0,2 % and with asymetric hypertrophy of left ventricle (> 15 mm). Obstructive form is clinically more significant and has worse prognosis.
As a cause of this disease more than 200 mutations on more than 10 genes were diagnosed till now. Symptomatology and prognosis of hypertophic cardiomyopathy is heterogenous – from asymptomatic course to sudden death.
Angina pectoris, effort dyspnoe or syncope are the most common symptoms. Mortality is estimated 1 % to 6 %.
Obstructive form is characterized by resting or provoked gradient > 30 mm Hg. In patients with obstructive form the risk of death, stroke and heart failure is higher as well as the risk of disease progression into the NYHA class III or IV.
In the treatment of this disease drugs, A-V sequential stimulation, surgical myectomy or alcohol septal ablation (ASA) are used. The most effective treatment of obstructive form are surgical myectomy and ASA