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Alcohol septal ablation for hypertrophic obstructive cardiomyopathy: indications, technical aspects and clinical results Volume 28, issue 6, November-December 2016

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Tables

Authors
Hôpital Privé Jacques-Cartier, Ramsay-générale de santé, Institut cardiovasculaire Paris-Sud, Département de cardiologie interventionnelle, 6, avenue du Noyer-Lambert, 91300 Massy, France
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Hypertrophic cardiomyopathy is the most common genetically transmitted heart disease. Approximately two thirds of patients develop symptoms caused by the dynamic left ventricular outflow tract obstruction, at rest or during effort. For these patients with hypertrophic obstructive cardiomyopathy (HOCM) that remain symptomatic despite optimal medical treatment, septal reduction should be discussed. While surgical myomectomy was considered the gold standard until the end of the 1990s, alcohol septal ablation (ASA) gained rapid popularity and acceptance, especially in Europe. In this review, we describe indications and contra-indications to ASA, along with technical considerations related to the procedure. Particular emphasis is put on adjunctive imaging modalities required for proper patient selection (echocardiography, magnetic resonance imaging) and procedure safety (echocardiography). Next, we describe post-procedural care and potential procedural complications. Finally, a review of the recent literature describing the long-term results of ASA is presented. In brief, when performed by an experienced team, ASA has a high success rate and low complication rate. The procedure provides symptom relief and grants the patients similar longevity to that of the general population.