Percutaneous Alcohol Septal Ablation for Hypertrophic

Percutaneous Alcohol Septal Ablation for Hypertrophic
Order 5893747
Percutaneous Alcohol Septal Ablation for Hypertrophic
1 A 43-year-old man with hypertrophic cardiomyopathy (HCM) and a resting left ventricular outflow tract
(LVOT) gradient of 60 mm Hg is referred to you for
alcohol septal ablation. He has dyspnea when walking
rapidly up a flight of stairs or more than two blocks
on level ground. His blood pressure is 140/80 mm
Hg and his heart rate is 85 bpm. His examination
is consistent with dynamic LVOT obstruction; however, there are no signs of heart failure. He is taking
12.5 mg of Toprol XL daily. You should:
(A) Arrange for left heart catheterization, to be
followed by alcohol ablation if severe coronary
artery disease is not present
(B) Increase his Toprol XL to 25 mg daily and
have him follow-up with his cardiologist for
up-titration of β-blockers as tolerated and then
reevaluate the symptom
(C) Refer him for surgical consultation because he
is too young for alcohol ablation
(D) Tell him that he should not be considered for
alcohol ablation unless he develops New York
Heart Association (NYHA) Class IV symptoms
Percutaneous Alcohol Septal Ablation for Hypertrophic
2 A 57-year-old patient with HCM presents to your
office because she is short of breath upon minimal
exertion. Echocardiography demonstrates mild systolic anterior motion (SAM) of the mitral valve leaflet
tips, mild mitral regurgitation (MR), and a resting
LVOT gradient of 10 mm Hg. What should you do
next?
(A) Perform alcohol septal ablation
(B) Refer her for myectomy
(C) Ask the sonographer to administer inhaled amyl
nitrate and/or arrange for a stress echocardiogram to determine if the LVOT gradient
increases with exercise
(D) Tell her that her symptoms are unlikely to be
related to LVOT obstruction
3 A 70-year-old patient with HCM with resting and
provocable LVOT gradients of 30 and 160 mm Hg,
respectively, comes to you for alcohol septal ablation.
She has NYHA functional Class IV symptoms in spite
of maximal medical therapy. Her echocardiogram
demonstrates normal left ventricular function, severe
asymmetric left ventricular hypertrophy with an
upper septal diameter of 2.0 cm, and SAM of the
anterior mitral valve leaflet. The anterior mitral valve
leaflet is excessively long and there is posterior mitral
valve leaflet override as a result. There is moderate
to severe MR at rest. Left heart catheterization shows
mild, nonobstructive coronary artery disease. You
should:
(A) Refer her for myectomy and repair of the mitral
valve
(B) Proceed with alcohol septal ablation because
you feel that her septal and valvular anatomy is
ideal for this form of therapy
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Percutaneous Alcohol Septal Ablation for Hypertrophic
Percutaneous Alcohol Septal Ablation for Hypertrophic Cardiomyopathy 271
(C) Proceed with alcohol septal ablation because she
does not have significant obstructive coronary
artery disease that requires coronary artery
bypass graft (CABG) surgery
4 Mortality following myectomy is much higher than
that following alcohol septal ablation.
(A) True
(B) False
5 A 75-year-old man with HCM and severe LVOT
obstruction comes to you because he wants alcohol
septal ablation. He heard that it was a noninvasive
procedure that will provide him with complete and
immediate relief of his symptoms. He is NYHA
functional Class III on maximum tolerated doses
of verapamil and disopyramide, has SAM of the
anterior mitral valve leaflet that is responsible for his
LVOT obstruction, and has no unfavorable anatomic
features to suggest that he would be better served by
myectomy. You should:
(A) Schedule him for alcohol septal ablation because
you feel confident that it will result in an immediate reduction in his LVOT gradient and,
therefore, immediate resolution of his current
symptoms
(B) Explain to him that while alcohol septal ablation
is less invasive than myectomy, the reduction
in LVOT gradient is not as complete immediately after alcohol ablation as that following
myectomy. As a result, he may not initially
experience a dramatic decrease in his symptoms
(C) Tell him that LVOT gradients are reduced
significantly following alcohol septal ablation;
however, the gradients gradually increase to
preprocedure levels within a year’s time
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