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Subject: Re: IHSS
Forum: The Heart Forum
Topic Area: Stenosis
Posted by CCF CARDIO MD - MTR on July 11, 1998 at 18:03:41:
In Reply to: IHSS posted by cabot on July 10, 1998 at 21:45:22:
i'm looking for information on options for the treatment of IHSS refractory to drug therapy. specifically, open heart to remove part of the septum and the other is a new experemental procedure, the septum is injected with alcohol to destroy part of the septum, a controlled heart attack
Dear Cabot, thank you for your question. IHSS is first treated with medications,
but when this disease becomes refractory to medications, other therapies must
be considered. Permanent pacemakers were tried for IHSS because when the heart
is paced, the activation of the septum is thought to be delayed to reduce the
outflow obstruction of the left ventricle (LV). Whether this happens is
controversial and a randomized trial from the Mayo Clinic failed to show any
benefit for pacing. Septal myectomy is a surgical procedure where a portion
of the thickened septum is surgically removed to relieve the outflow obstruction.
Results are good with this procedure but it involves major cardiac surgery with
the risks of a postoperative VSD (hole in the septum), complete heart block
requiring a permanent pacemaker, and the typical risks of open heart surgery
(pneumonia, rhythm disturbances, blood clots, etc). Only experienced surgeons
should attempt a myectomy because of the risks of the procedure. The septum
can enlarge again after surgery but there's no reliable way to determine in whom
this may happen. In an effort to provide septal reduction to more patients (many
of whom would not be good surgical candidates), a group of cardiologists in
Germany developed a procedure called alcohol septal ablation. This procedure
takes place during a heart catheterization (which is not open heart surgery) and
involves selectively blocking a branch of the left anterior descending coronary
artery which supplies the septum. Absolute alcohol is instilled into the arterial
side branch to cause a controlled heart attack. The septal tissue that is supplied
by this side branch theoretically will thin after the controlled heart attack
and this will relieve the LV outflow obstruction. Results with this procedure
have been variable and not all patients respond. In the U.S., septal ablation
remains an experimental procedure and is only done at major cardiac centers. Our
institution has performed around 12 procedures so far and the results have been
mixed. Recently, we reviewed the results of a few other cardiac centers in the
U.S. and the final opinion on this procedure is still forthcoming. If you or
someone you know has IHSS and would like more information on septal myectomy
and septal ablation or would like to be evaluated at Cleveland Clinic, please
call 1-800-CCF-CARE and ask for the office of Dr. Harry Lever of Cardiology. Dr.
Lever is an international expert on treating patients with IHSS. I hope you find
this information useful. Information provided in the heart forum is for general purposes only. Specific
diagnoses and therapies can only be provided by your physician.
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