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2013, Número 4

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Rev Med Inst Mex Seguro Soc 2013; 51 (4)


Ablación septal con alcohol para tratar miocardiopatía hipertrófica

López-Aburto G, Palacios-Rodríguez JM, Cantú-Ramírez S, Galván-García E, Tolosa-Dzul G, Morán-Benavente A, Ontiveros-Martíneza R

Idioma: Español
Referencias bibliográficas: 50
Paginas: 396-401
Archivo PDF: 122.30 Kb.


RESUMEN

Objetivo: conocer características demográfi cas, clínicas y hemodinámicas de los pacientes con ablación con alcohol para tratar la miocardiopatía hipertrófi ca septal obstructiva (MHSO).
Métodos: estudio observacional, longitudinal, descriptivo de 21 pacientes con MHSO resistente a tratamiento o con gradiente = 30 mm Hg en reposo o = 60 mm Hg provocado y con movimiento sistólico anterior o insufi ciencia mitral › grado II.
Resultados: edad de 50 ± 16 años; hombres 38.1 % y mujeres 61.9 %. Los síntomas fueron angor 42.9 %, disnea 85.7 % y síncope 23.8 %. La clase funcional NYHA preablación fue grados III y IV en 61.9 %; al año todos tenían grados I y II. Preablación y al año, el espesor del septo interventricular fue de 22.7 ± 4.9 y 20.7 ± 3.1 mm. Preablación, después y al año, la fracción de eyección fue de 65.5 ± 7, 62.2 ± 6.5 y 68.7 ± 6.2 %. Preablación, después y al año, el gradiente del tracto de salida del ventrículo izquierdo fue de 106.9 ± 29.9, 44.6 ± 24.3 y 22.0 ± 5.7 mm Hg. Preablación, la insufi ciencia mitral fue grados III y IV en 33.3 y 47.6 % y al año fue grados 0 en 52.4 %, I en 28.6 % y II en 19 %. No hubo defunciones intrahospitalarias.
Conclusiones: la ablación septal con alcohol en pacientes con MHSO fue exitosa.


REFERENCIAS (EN ESTE ARTÍCULO)

  1. Richardson, P, McKenna W, Bristow M, et al. Report of the 1995 World Health Organization/International Society and Federation of Cardiology Task Force on the Defi nition and Classifi cation of cardiomyopathies. Circulation. 1996;93(5):841-2. Texto libre en http://circ.ahajournals.org/content/93/5/841.long

  2. Maron BJ, Bonow RO, Cannon RO 3rd, et al. Hypertrophic cardiomyopathy. Interrelations of clinical manifestations, pathophysiology, and therapy (2). N Engl J Med. 1987;316(14):844-52.

  3. Maron BJ, Spirito P, Wesley Y, et al. Development and progression of left ventricular hypertrophy in children with hypertrophic cardiomyopathy. N Engl J Med. 1986;315(10):610-4.

  4. Charron P, Dubourg O, Desnos M, et al. Clinical features and prognostic implications of familial hypertrophic cardiomyopathy related to the cardiac myosin-binding protein C gene. Circulation. 1998;97(22):2230-6. Texto libre en http://circ.ahajournals. org/content/97/22/2230.long

  5. Niimura H, Bachinski LL, Sangwatanaroj S, et al. Mutations in the gene for cardiac myosin-binding protein C and late-onset familial hypertrophic cardiomyopathy. N Engl J Med. 1998;338(18):1248-57.

  6. Maron BJ, Niimura H, Casey SA, et al. Development of left ventricular hypertrophy in adults in hypertrophic cardiomyopathy caused by cardiac myosinbinding protein C gene mutations. J Am Coll Cardiol. 2001;38(2):315-21.

  7. Niimura H, Patton KK, McKenna WJ, et al. Sarcomere protein gene mutations in hypertrophic cardiomyopathy of the elderly. Circulation. 2002;105 (4):446-51. Texto libre en http://circ.ahajournals.org/ content/105/4/446.full.pdf+html

  8. Kubo T, Kitaoka H, Okawa M, et al. Lifelong left ventricular remodeling of hypertrophic cardiomyopathy caused by a founder frame shift deletion mutation in the cardiac myosin-binding protein C gene among Japanese. J Am Coll Cardiol. 2005;46(9):1737-43.

  9. Moolman JA, Reith S, Uhl K, et al. A newly created splice donor site in exon 24 of the MyBP-C gene is responsible for inherited hypertrophic cardiomyopathy with incomplete disease penetrance. Circulation. 2000;101(12):1396-402. Texto libre en http://circ.ahajournals. org/content/101/12/1396.full.pdf+html

  10. Maron BJ, Casey SA, Poliac, LC, et al. Clinical course of hypertrophic cardiomyopathy in a regional United States cohort. JAMA. 1999;281(7):650-5. Texto libre en http://jama.jamanetwork.com/article. aspx?articleid=188775

  11. Kimmelstiel CD, Maron BJ. Role of percutaneous septal ablation in hypertrophic obstructive cardiomyopathy. Circulation. 2004;109(4):452-6.

  12. Knight C, Kurbaan AS, Seggeweiss H, et al. Nonsurgical septal reduction for hypertrophic obstructive cardiomyopathy: outcome of the fi rst series of patients. Circulation. 1997; 95(8):2075-81. Texto libre http://circ.ahajournals.org/content/95/8/2075.long

  13. Faber L, Seggewiss H, Gleichmann U. Percutaneous transluminal septal myocardial ablation in hypertrophic obstructive cardiomyopathy: results with respect to intraprocedural myocardial contrast echocardiography. Circulation. 1998;98(22):2415-21.

  14. Gietzen FH, Leuner CJ, Raute-Kreinsen U, et al. Acute and long-term results after transcoronary ablation of septal hypertrophy (TASH). Catheter interventional treatment for hypertrophic obstructive cardiomyopathy. Eur Heart J. 1999;20(18):1342-54.

  15. Lakkis NM, Nagueh SF, Kleiman NS, et al. Echocardiography- guided ethanol septal reduction for hypertrophic obstructive cardiomyopathy. Circulation. 1998;98(17):1750-5. Texto libre en http://circ. ahajournals.org/content/98/17/1750.full.pdf+html

  16. Nagueh SF, Lakkis NM, Middleton KJ, et al. Changes in left ventricular fi lling and left atrial function six months after nonsurgical septal reduction therapy for hypertrophic obstructive cardiomyopathy. J Am Coll Cardiol. 1999;34(4):1123-8.

  17. Flores-Ramírez R, Lakkis NM, Middleton KJ, et al. Echocardiographic insights into the mechanisms of relief of left ventricular outfl ow tract obstruction after nonsurgical septal reduction therapy in patients with hypertrophic obstructive cardiomyopathy. J Am Coll Cardiol. 2001;37(1):208-14.

  18. Braunwald E. Induced septal infarction: a new therapeutic strategy for hypertrophic obstructive cardiomyopathy. Circulation. 1997;95(8):1981-2. Texto libre en http://circ.ahajournals.org/content/95/ 8/1981.long

  19. Sigwart U. Non-surgical myocardial reduction for hypertrophic obstructive cardiomyopathy. Lancet. 1995;346(8969):211-4.

  20. Rivera S, Sitges M, Azqueta M, et al. Remodelado ventricular izquierdo tras ablación septal percutánea con alcohol en pacientes con miocardiopatía hipertrófi ca obstructiva: estudio ecocardiográfi co. Rev Esp Cardiol. 2003;56(12):1174-81. Texto libre en http://apps.elsevier.es/watermark/ctl_servlet?_ f=10&pident_articulo=13055335&pident_usuario =0&pcontactid=&pident_revista=25&ty=169&acció n=L&origen=cardio&web=http://www.revespcardiol. org&lan=es&fi chero=25v56n12a13055335pdf001. pdf

  21. Coats AJ, Henein M, Flather M, et al. Retraction: Shamim et al. Nonsurgical reduction of the interventricular septum in patients with hypertrophic cardiomyopathy. N Engl J Med. 2002;347:1326-33. N Engl J Med. 2003 348(10):951. Texto libre en http://www. nejm.org/doi/pdf/10.1056/NEJMc035061

  22. Lakkis N. New treatment methods for patients with hypertrophic obstructive cardiomyopathy. Curr Opin Cardiol. 2000;15(3):172-7.

  23. Knight C, Kurbaan AS, Seggewiss H, et al. Nonsurgical septal reduction for hypertrophic obstructive cardiomyopathy: outcome in the fi rst series of patients. Circulation. 1997;95(8):2075-81.

  24. Gietzen F, Leuner Ch, Gerenkamp T, et al. Relief of obstruction in hypertrophic cardiomyopathy by transient occlusion of the fi rst septal branch of the left coronary artery. Eur Heart J. 1994;15 (Abstr Suppl):125.

  25. Faber L, Seggewiss H, Gleichmann U. Percutaneous transluminal septal myocardial ablation in hypertrophic obstructive cardiomyopathy: results with respect to intraprocedural myocardial contrast echocardiography. Circulation. 1998;98(22):2415- 21. Texto libre en http://circ.ahajournals.org/content/ 98/22/2415.full.pdf+html

  26. Richardson, P, McKenna W, Bristow M, et al. Report of the 1995 World Health Organization/International Society and Federation of Cardiology Task Force on the Defi nition and Classifi cation of cardiomyopathies. Circulation. 1996;93(5):841-2. Texto libre en http://circ.ahajournals.org/content/93/5/841.long

  27. Maron BJ, Bonow RO, Cannon RO 3rd, et al. Hypertrophic cardiomyopathy. Interrelations of clinical manifestations, pathophysiology, and therapy (2). N Engl J Med. 1987;316(14):844-52.

  28. Maron BJ, Spirito P, Wesley Y, et al. Development and progression of left ventricular hypertrophy in children with hypertrophic cardiomyopathy. N Engl J Med. 1986;315(10):610-4.

  29. Charron P, Dubourg O, Desnos M, et al. Clinical features and prognostic implications of familial hypertrophic cardiomyopathy related to the cardiac myosin-binding protein C gene. Circulation. 1998;97(22):2230-6. Texto libre en http://circ.ahajournals. org/content/97/22/2230.long

  30. Niimura H, Bachinski LL, Sangwatanaroj S, et al. Mutations in the gene for cardiac myosin-binding protein C and late-onset familial hypertrophic cardiomyopathy. N Engl J Med. 1998;338(18):1248-57.

  31. Maron BJ, Niimura H, Casey SA, et al. Development of left ventricular hypertrophy in adults in hypertrophic cardiomyopathy caused by cardiac myosinbinding protein C gene mutations. J Am Coll Cardiol. 2001;38(2):315-21.

  32. Niimura H, Patton KK, McKenna WJ, et al. Sarcomere protein gene mutations in hypertrophic cardiomyopathy of the elderly. Circulation. 2002;105 (4):446-51. Texto libre en http://circ.ahajournals.org/ content/105/4/446.full.pdf+html

  33. Kubo T, Kitaoka H, Okawa M, et al. Lifelong left ventricular remodeling of hypertrophic cardiomyopathy caused by a founder frame shift deletion mutation in the cardiac myosin-binding protein C gene among Japanese. J Am Coll Cardiol. 2005;46(9):1737-43.

  34. Moolman JA, Reith S, Uhl K, et al. A newly created splice donor site in exon 24 of the MyBP-C gene is responsible for inherited hypertrophic cardiomyopathy with incomplete disease penetrance. Circulation. 2000;101(12):1396-402. Texto libre en http://circ.ahajournals. org/content/101/12/1396.full.pdf+html

  35. Maron BJ, Casey SA, Poliac, LC, et al. Clinical course of hypertrophic cardiomyopathy in a regional United States cohort. JAMA. 1999;281(7):650-5. Texto libre en http://jama.jamanetwork.com/article. aspx?articleid=188775

  36. Kimmelstiel CD, Maron BJ. Role of percutaneous septal ablation in hypertrophic obstructive cardiomyopathy. Circulation. 2004;109(4):452-6.

  37. Knight C, Kurbaan AS, Seggeweiss H, et al. Nonsurgical septal reduction for hypertrophic obstructive cardiomyopathy: outcome of the fi rst series of patients. Circulation. 1997; 95(8):2075-81. Texto libre http://circ.ahajournals.org/content/95/8/2075.long

  38. Faber L, Seggewiss H, Gleichmann U. Percutaneous transluminal septal myocardial ablation in hypertrophic obstructive cardiomyopathy: results with respect to intraprocedural myocardial contrast echocardiography. Circulation. 1998;98(22):2415-21.

  39. Gietzen FH, Leuner CJ, Raute-Kreinsen U, et al. Acute and long-term results after transcoronary ablation of septal hypertrophy (TASH). Catheter interventional treatment for hypertrophic obstructive cardiomyopathy. Eur Heart J. 1999;20(18):1342-54.

  40. Lakkis NM, Nagueh SF, Kleiman NS, et al. Echocardiography- guided ethanol septal reduction for hypertrophic obstructive cardiomyopathy. Circulation. 1998;98(17):1750-5. Texto libre en http://circ. ahajournals.org/content/98/17/1750.full.pdf+html

  41. Nagueh SF, Lakkis NM, Middleton KJ, et al. Changes in left ventricular fi lling and left atrial function six months after nonsurgical septal reduction therapy for hypertrophic obstructive cardiomyopathy. J Am Coll Cardiol. 1999;34(4):1123-8.

  42. Flores-Ramírez R, Lakkis NM, Middleton KJ, et al. Echocardiographic insights into the mechanisms of relief of left ventricular outfl ow tract obstruction after nonsurgical septal reduction therapy in patients with hypertrophic obstructive cardiomyopathy. J Am Coll Cardiol. 2001;37(1):208-14.

  43. Braunwald E. Induced septal infarction: a new therapeutic strategy for hypertrophic obstructive cardiomyopathy. Circulation. 1997;95(8):1981-2. Texto libre en http://circ.ahajournals.org/content/95/ 8/1981.long

  44. Sigwart U. Non-surgical myocardial reduction for hypertrophic obstructive cardiomyopathy. Lancet. 1995;346(8969):211-4.

  45. Rivera S, Sitges M, Azqueta M, et al. Remodelado ventricular izquierdo tras ablación septal percutánea con alcohol en pacientes con miocardiopatía hipertrófi ca obstructiva: estudio ecocardiográfi co. Rev Esp Cardiol. 2003;56(12):1174-81. Texto libre en http://apps.elsevier.es/watermark/ctl_servlet?_ f=10&pident_articulo=13055335&pident_usuario =0&pcontactid=&pident_revista=25&ty=169&acció n=L&origen=cardio&web=http://www.revespcardiol. org&lan=es&fi chero=25v56n12a13055335pdf001. pdf

  46. Coats AJ, Henein M, Flather M, et al. Retraction: Shamim et al. Nonsurgical reduction of the interventricular septum in patients with hypertrophic cardiomyopathy. N Engl J Med. 2002;347:1326-33. N Engl J Med. 2003 348(10):951. Texto libre en http://www. nejm.org/doi/pdf/10.1056/NEJMc035061

  47. Lakkis N. New treatment methods for patients with hypertrophic obstructive cardiomyopathy. Curr Opin Cardiol. 2000;15(3):172-7.

  48. Knight C, Kurbaan AS, Seggewiss H, et al. Nonsurgical septal reduction for hypertrophic obstructive cardiomyopathy: outcome in the fi rst series of patients. Circulation. 1997;95(8):2075-81.

  49. Gietzen F, Leuner Ch, Gerenkamp T, et al. Relief of obstruction in hypertrophic cardiomyopathy by transient occlusion of the fi rst septal branch of the left coronary artery. Eur Heart J. 1994;15 (Abstr Suppl):125.

  50. Faber L, Seggewiss H, Gleichmann U. Percutaneous transluminal septal myocardial ablation in hypertrophic obstructive cardiomyopathy: results with respect to intraprocedural myocardial contrast echocardiography. Circulation. 1998;98(22):2415- 21. Texto libre en http://circ.ahajournals.org/content/ 98/22/2415.full.pdf+html




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