1. Treatment of hypertrophic obstructive cardiomyopathy with alcohol ablation Kulić M., Spužić M., Tahirović E., Mujačić V., Šošević A., Perva O., Ćibo M., Zorman D.* Centar za srce, KCU Sarajevo *Univerzitetni klinični center Ljubljana V Congress of Cardiologists BiH with international participation, Radon Plaza, Sarajevo, 27-29 may, 2010.

2. Def. Hypertrophic obstructive cardiomyopathy – primary genetic cardiac disorder, characterized with massive myocardial hypertrophy, with dynamic left ventricular outflow tract obstruction and diastolic dysfunction of the left ventricle. Kulić M, Spužić M, Tahirović E et al. Treatment of HOCM with alcohol ablation

3. Symptoms:  Angina,  Dyspnea,  Syncope,  Uncomfortable awareness of the heart beat (palpitations). Kulić M, Spužić M, Tahirović E et al. Treatment of HOCM with alcohol ablation

4. Treatment:  Medicamention;  Surgical myectomy;  Ventricular pacing;  Alcohol septal ablation – PTSMA* (Sigwart method) *PTSMA - percutaneous transluminal septal myocardial ablation Kulić M, Spužić M, Tahirović E et al. Treatment of HOCM with alcohol ablation

5. Nishimura R. and Holmes D. NEJM 2004 350:1320 Kulić M, Spužić M, Tahirović E et al. Treatment of HOCM with alcohol ablation

6. Table 1. Characteristics of patients before PTSMA

7. Kulić M, Spužić M, Tahirović E et al. Treatment of HOCM with alcohol ablation

9.  Female patient 33 years old,  She was taken to Neurological Clinic because of syncope and family history of epilepsy. and family history of epilepsy.  After few weeks of treatment with antiepileptic, she had again dyspnea, syncopes and NYHA IV. she had again dyspnea, syncopes and NYHA IV.  ECHO IVSs 28mm, LVPWs 22mm, SAM, LVOTPG max 85mmHG, MR moderate, TRPGmax LVOTPG max 85mmHG, MR moderate, TRPGmax 35mmHg. 35mmHg.  ECG – HLV, without of heart rhythm disorders. Kulić M, Spužić M, Tahirović E et al. Treatment of HOCM with alcohol ablation CASE REPORT

10.  Started medication therapy (high doses of Beta-blockers – metoprolol) – unsuccessful !  Surgical myectomy – (Morrow method), four years after surgical myectomy without symptoms!  After four years again same symptoms like as dyspnea angina, syncope episodes.  ECHO IVSd 26mm (on the place surgical myectomy), LVOTPG mean 49mmHg, SAM, MR moderate.  Alcohol septal ablation – (Sigwart method). Kulić M, Spužić M, Tahirović E et al. Treatment of HOCM with alcohol ablation

12. HEMOD Y NAMIC DATA

13. PTSMA video Kulić M, Spužić M, Tahirović E et al. Treatment of HOCM with alcohol ablation

14. Conclusions  Invasive cardiology method,  Provides symptomatic relief,  Leads to hemodynamic improvement,  Refractory on medication therapy,  Unsuccessful surgical myectomy.

15. Thank you for your attention, Greetings from ” Department of Invasive Cardiology - Heart centre Sarajevo”!