Treatment With Microspheres in Patients With Obstructive Hypertrophic Cardiomyopathy: An Old Therapy Tries to Emerge With Long-Term Outcome Data.

Hypertrophic cardiomyopathy is a relatively frequent genetic disease with a prevalence of 1/500 to 1/200; about two-thirds of patients have an obstructive variant (hypertrophic obstructive cardiomyopathy [HOCM]). 1 Maron BJ Desai MY Nishimura RA Spirito P Rakowski H Towbin JA Dearani JA Rowin EJ Maron MS Sherrid MV Management of hypertrophic cardiomyopathy: JACC state-of-the-art review. J Am Coll Cardiol. 2022; 79: 390-414 Crossref PubMed Scopus (81) Google Scholar Left ventricular outflow tract (LVOT) obstruction occurs in the setting of a hypertrophied anterobasal septum and systolic anterior motion of the mitral valve; high gradients can lead to acute or chronic heart failure, syncope, and an increased risk of sudden cardiac death. Various options to decrease or relieve the obstruction have been employed, including medical therapy to reduce the force and velocity of left ventricular contraction, right ventricular pacing to induce dyssynchrony of the septal contraction, and alcohol septal ablation (ASA) or surgical myectomy to reduce septal thickness. To date, the gold standard for reducing LVOT obstruction remains surgical myectomy; during this procedure, the abnormal mitral valve apparatus geometry can be addressed as well. 1 Maron BJ Desai MY Nishimura RA Spirito P Rakowski H Towbin JA Dearani JA Rowin EJ Maron MS Sherrid MV Management of hypertrophic cardiomyopathy: JACC state-of-the-art review. J Am Coll Cardiol. 2022; 79: 390-414 Crossref PubMed Scopus (81) Google Scholar