Liječenje bolesnika s opstruktivnom hipertrofijskom kardiomiopatijom metodom alkoholne septalne ablacije

master's thesis

• Title (english): Treatment of patients with obstructive hypertrophic cardiomyopathy using alcohol septal ablation
• Author: Martina Vidović
• Mentor: Boško Skorić (mentor)
• Committee member: Joško Bulum (predsjednik povjerenstva)
• Committee member: Martina Lovrić Benčić (član povjerenstva)
• Committee member: Boško Skorić (član povjerenstva)
• Granter: University of Zagreb; School of Medicine; (Department of Internal Medicine); Zagreb
• Defense date and country: 2024-07-12, Croatia
• Scientific / art field, discipline and subdiscipline: BIOMEDICINE AND HEALTHCARE; Clinical Medical Sciences; Internal Medicine

Abstract

Hipertrofijska kardiomiopatija (HCM) je nasljedna bolest miokarda karakterizirana hipertrofijom lijeve klijetke u odsutnosti bilo kojeg drugog uzroka hipertrofije. HCM pogađa otprilike 1 od 500 osoba, a kod otprilike 60% pacijenata javlja se opstrukcija izlaznog trakta lijeve klijetke (LVOTO) te se u tom slučaju radi o opstruktivnoj hipertrofijskoj kardiomiopatiji (HOCM). Liječenje HOCM uključuje medikamentoznu i inzvazivnu terapiju, odnosno septalnu redukcijsku terapiju (SRT) koja uključuje kiruršku septalnu miektomiju (SM) i perkutanu alkoholnu septalnu ablaciju (ASA). SRT se primjenjuje kod pacijenata sa HOCM koji ostaju simptomatski unatoč farmakoterapiji. Alkoholna septalna ablacija (ASA) je minimalni invazivni postupak u kojem se koristi 96% etanol za ciljanu ablaciju hipertrofičnog septuma, a rezultat je dugoročno smanjenje LVOTO. Postupak uključuje identifikaciju ciljane septalne arterije pomoću ehokardiografije kako bi se osiguralo precizno mjesto ablacije, postavljanje balonskog katetera koji izolira ciljanu arteriju od ostatka koronarne cirkulacije i selektivno ubrizgavanje etanola u ovaj ogranak. Dugoročni ishodi ASA usporedivi su sa septalnom miektomijom (SM), uz niži rizik od perioperativnih komplikacija. ASA se sve više primjenjuje kao terapijska metoda izbora, ne samo kod starijih pacijenata s visokim operativnim rizikom, već i u širem spektru pažljivo odabranih pacijenata. Komplikacije povezane s ASA uključuju nastanak kompletnog atrioventrikularnog (AV) bloka, što može zahtijevati postavljanje trajnog elektrostimulatora srca (PPM). Važno je pažljivo monitorirati bolesnike tijekom i nakon postupka, posebno u prvih nekoliko dana zbog mogućnosti pojave odgođenog srčanog bloka. ASA je postala ključna metoda u liječenju HOCM, posebno u centrima s visokim brojem učinjenih zahvata i većim iskustvom, zbog čega su ishodi značajno bolji.

Abstract (english)

Hypertrophic cardiomyopathy (HCM) is an inherited myocardial disease characterized by left ventricular hypertrophy in the absence of any other cause of hypertrophy. HCM affects approximately 1 in 500 people, and about 60% of patients develop left ventricular outflow tract obstruction (LVOTO), which then classifies as obstructive hypertrophic cardiomyopathy (HOCM). Treatment of HOCM includes both pharmacological and invasive therapy, that is septal reduction therapy (SRT), which encompasses surgical septal myectomy (SM) and percutaneous alcohol septal ablation (ASA). SRT is indicated for patients with HOCM who remain symptomatic despite pharmacotherapy. Alcohol septal ablation (ASA) is a minimally invasive procedure that uses 96% ethanol for targeted ablation of the hypertrophic septum, resulting in a long-term reduction of LVOTO. The procedure involves identification of the target septal artery using echocardiography to ensure precise ablation location, placing a balloon catheter that isolates the target artery from the rest of the coronary circulation, and selectively injecting ethanol into this branch. Long-term outcomes of ASA are comparable to septal myectomy (SM), with a lower risk of perioperative complications. ASA is increasingly used as the therapeutic method of choice, not only for older patients with high surgical risk but also for a broader spectrum of carefully selected patients. Complications associated with ASA include the development of complete atrioventricular (AV) block, which may require the placement of a permanent pacemaker (PPM). It is crucial to closely monitor patients during and after the procedure, particularly in the first few days, due to the possibility of delayed heart block. ASA has become a pivotal method in the treatment of HOCM, especially in centers with high procedural volume and greater experience, resulting in significantly better outcomes.

• Keywords: Hipertrofijska kardiomiopatija; Opstrukcija izlaznog trakta lijeve klijetke; Alkoholna septalna ablacija; AV blok
• Keywords (english): Hypertrophic cardiomyopathy; Left ventricular outflow tract obstruction; Alcohol septal ablation; AV block
• Language: croatian
• URN:NBN: urn:nbn:hr:105:876977
• Study programme: Title: Medicine; Study programme type: university; Study level: integrated undergraduate and graduate; Academic / professional title: doktor/doktorica medicine (doktor/doktorica medicine)
• Type of resource: Text
• File origin: Born digital
• Access conditions: Open access
• Created on: 2024-06-27 09:46:36