Efficacy of nonsurgical septal reduction therapy in symptomatic patients with obstructive hypertrophic cardiomyopathy and provocable gradients

The hemodynamic burden caused by left ventricular obstruction along with impaired systolic and diastolic function explains the disabling symptoms of heart failure that are common in patients with obstructive hypertrophic cardiomyopathy (HC).(1) Relief of the outflow obstruction is the cornerstone of the successful treatment of this disease.(2) Medical therapy with negative inotropic medications like beta blockers, calcium antagonists, and disopyramide are the first line of treatment.(3,4) Many patients, however, continue to experience symptoms despite optimal medical therapy. These patients are left with 3 options: myotomymyomectomy,(5-7) dual-chamber pacing,(8-12) or nonsurgical septal reduction.(13-20) In this report, we share our experience with nonsurgical septal reduction in symptomatic patients with low resting gradients (< 30 mm Hg), and significant (> 60 mm Hg) provocable gradients after the infusion of low-dose dobutamine.