熱帯病と公衆衛生ジャーナル

概要

Updates in Alcohol Septal Ablation for Hypertrophic Obstructive Cardiomyopathy

Josef Veselka

The first Alcohol Septal Ablation (ASA) was performed more than 20 years ago (1994); since then, it has become a widely used technique for the treatment of highly symptomatic patients with hypertrophic obstructive cardiomyopathy. It has been shown that post-procedural basal septal shrinking as a result of myocardial scarring is followed by a decrease of the left ventricular obstruction, regression of left ventricular hypertrophy within the first post-procedural year, improvement of diastolic function, and reduction of the degree of mitral regurgitation. All of these changes are accompanied by significant symptom relief. Although there is rather limited evidence of post-procedural long-term survival, all of the presented studies are consistent in the low incidence of sudden death and similar prognosis with age- and the sex-matched general population. Recently, studies dealing with mildly symptomatic patients and younger patients demonstrated the encouraging long-term outcome of ASA patients. Also, it has been shown that a post-ASA residual obstruction is an independent predictor of worse post-procedural course.