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Myectomy vs Septal Ablation

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  • Myectomy vs Septal Ablation

    [Myectomy vs Septal Ablation]

    Author: Bob Pensack,MD (---.tnt2.steamboat-springs.co.da.uu.net)

    Date: 10-17-02 16:34

    Dear Erica,

    Sorry, but I sent you a rather extensive e-mail this morning which was somehow lost. Unfortunately I did not save it so this will be a new attempt. You are indeed correct in your assumption that alcohol septal ablation of the septum is still a controversial issue. The larger centers such as the Mayo and Cleveland Clinic as well as Dr. Maron at the Minneapolis Heart Institute are in fact concerned that as of yet there is no long track record to see long term outcome results and possible complications down the road. They now have over a 40 year experience with septal myectomies, which have produced, for the most-part excellent results. Indeed this is why this surgery is still considered "the gold standard" for treatment obstructive HCM. The operative mortality rate in the hands of the best surgeons is close to 0%. I must emphasize however that only a few surgeons in the country have this vast experience with HCM. One of these is Dr. Gordon K. Danielson of the Mayo Clinic.

    On the other hand, Dr. William Spencer at the Medical University of South Carolina has the largest experience of alcohol septal ablation of any cardiologist in the United States. The overwhelming majority of his patients have done really well. He was trained by Dr. Hubert Seggewiss of Schweinfurt, Germany, who developed the technique. Dr. Spencer, as you probably already know, recently moved to SC from Baylor (the Texas Heart Institute) where he perfected his techniques.

    Your father's septum size of 3 to 3.5 sonometers is not a prognosticator of sudden death by itself. The true risk factors for sudden death, as outlined recently, at the HCM International Summit on Oct 4-6 are as follows: a) finding of 2 or more of the following features are felt to be associated with a higher incidence of sudden death 1) a family history of 2 or more premature (less than 40 years) sudden deaths 2) syncope within the previous year 3) the finding of nonsustained ventricular tachycardia on Holter 4) an abnormal exercise blood pressure response 5) severe left ventricular wall hypertrophy (greater than or equal to 3 sonometers) 6) a large left ventricular outflow tract obstructive gradient.

    It is generally felt that the finding of 2 or more above is associated with annual sudden death rates of 2-4%. It should be emphasized that these are not hard and fast rules and that each patient must be evaluated as an individual. It is felt that if the patient meets the above criteria it is a good idea for those patients to receive an AICD (Automatic Implantable Cardiac Defibrillator). Decisions for the above must be individualized based on age, intensity of the risk factors, etc.

    For what it is worth, if it was me or one of my loved ones, I would chose an alcohol septal ablation if the criteria for that is met by Dr. Spencer. If this did not produce the desired results, the gold standard of myectomy could still be done.

    I hope this answers all of your questions about your father. Please feel free to contact me in regards to all our HCM brothers and sisters.

    Sincerely,

    Bob Pensack, M.D.

    >From: Erica Stolzenberg

    >To: [email protected]

    >Subject: HCM and all you folks on this message board

    >Date: Wed, 16 Oct 2002 19:42:57 -0700 (PDT)

    >

    >

    >Dear Dr. Pensack:

    >

    >Thank you for posting on the HCMA board. I have a question for you about the septal alcohol ablation procedure. My father turns 58 on November 4th and he is scheduled to have his ablation on November 12th at the MUSC in SC. He was first diagnosed with IHSS in the mid to late 90's ... before that he was just told that he had high blood pressure and a murmur. He was officially diagnosed with the term HOCM a few weeks ago by his local cardiologist here in Cary, NC. He had his cath a few weeks ago and it was recommended that he either go for an ablation or myectomy. His septum size is 3.0 - 3.5. I asked his cardiologist if he was at high risk for sudden cardiac death and he said no (but I am keeping in mind that he is not an HCM specialist and could be uneducated about the true nature of HCM/HOCM. I also know my family history contains many deaths on my father’s side due to heart disease – heart attacks & strokes from my father’s age +) Dr. Spencer at the MUSC will evaluate my father on the morning of Nov.12th. He is scheduled to have the ablation that afternoon if Dr. Spencer believes he is a true match. Personally, I would love for my father to see an HCM specialist but he refuses to go to the Mayo Clinic or any other HCM center. I know it is because he is fearful of the myectomy. He feels that because these centers oppose the ablation … they will try and talk him out of it. I have been trying to convince him that their bias is only because the procedure is new and there isn't enough long-term data to back up their 'support.' I have been reading on the board that the procedure is not recommended for the younger population. My father obviously does not fall into this category but I just don’t know if he is making a wise decision. I welcome your thoughts on the procedure. I also welcome any additional thoughts or recommendations you might have to help me further educate my father! I love him and I do not want to misinform him. He listens to me because I am his first-born daughter who loves him dearly, and he listens to me because he knows I have a true understanding of health education. I attained my BS degree in Health Science with a dual concentration in Community and School health education (grades N-12.) Thank you in advance and I look forward to your reply!

    >

    >

    >

    >Best regards,

    >

    >Erica Stolzenberg

    >3 Trawick Court

    >Durham, NC 27713

    ~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~

    [Re: Myectomy vs Septal Ablation]

    Author: Erica Stolzenberg (---.biz.dsl.gtei.net)

    Date: 10-17-02 16:47

    Thank you so much! I will pass this along to my father and get back to you soon!

    Kindest regards, Erica Beth Stolzenberg

    PS- I ordered your book this morning and look forward to reading it! : )

    ~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~

    [Re: Myectomy vs Septal Ablation]

    Author: Erica Stolzenberg (---.biz.dsl.gtei.net)

    Date: 10-21-02 09:21

    Lisa ... please check your email. It is urgent that I speak with you!
    NOTE: This is a post from the previous forum message board.

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