Septal Reduction Therapy

Septal reduction therapy, also known as septal myectomy or alcohol septal ablation, is a medical procedure used to treat hypertrophic cardiomyopathy (HCM). HCM is a genetic heart condition where the heart muscle becomes thickened, leading to various symptoms and complications. Septal reduction therapy aims to improve heart function and relieve symptoms by reducing the thickness of the thickened heart muscle.

 

Types

There are two main types of septal reduction therapy:

  • Surgical Myectomy: In this open-heart surgical procedure, the thickened portion of the heart muscle is removed to alleviate the obstruction and improve blood flow.
  • Alcohol Septal Ablation (ASA): This is a less invasive alternative to surgical myectomy, where alcohol is injected into a specific artery to cause controlled damage to the thickened heart muscle and promote thinning.

 

Treatments

Septal reduction therapy is performed to:

  • Relieve symptoms: HCM can cause symptoms like chest pain, shortness of breath, fatigue, and palpitations. The therapy aims to reduce these symptoms and improve the patient’s quality of life.
  • Improve heart function: By reducing the obstruction caused by the thickened heart muscle, septal reduction therapy allows for better blood flow and improved heart function.

 

Before the procedure

Preparing for septal reduction therapy may involve:

  • Medical evaluation: Your healthcare team will perform a comprehensive assessment of your overall health, including imaging tests and diagnostic procedures.
  • Medication management: You may be advised to adjust or stop certain medications before the procedure, as directed by your healthcare provider.
  • Fasting: You will be instructed to fast for a specified period before the procedure to ensure an empty stomach.

 

During the procedure

  • Anesthesia: The procedure is typically performed under local anesthesia with mild sedation or under general anesthesia, depending on the approach and patient preference.
  • Catheter insertion: A catheter is inserted into a blood vessel, usually in the groin or leg, and guided to the heart using imaging techniques.
  • Alcohol injection: Alcohol is injected into a specific artery that supplies the thickened heart muscle. The alcohol causes controlled damage to the muscle, leading to thinning over time.

 

After the procedure

  • Recovery: You will be closely monitored in a recovery area until you are stable. The procedure is typically performed on an inpatient basis, and most patients stay in the hospital for observation for a day or two.
  • Follow-up care: Regular follow-up appointments will be scheduled to monitor your progress and evaluate the effectiveness of the therapy.

 

Advantages

  • Symptom relief: Septal reduction therapy can provide significant relief from symptoms associated with HCM, such as chest pain and shortness of breath.
  • Improved heart function: By reducing the obstruction caused by the thickened heart muscle, septal reduction therapy allows for better blood flow and improved heart function.
  • Less invasive: ASA is a less invasive alternative to surgical myectomy, with potentially shorter hospital stays and faster recovery.

 

Risks

While septal reduction therapy is generally considered safe and effective, there are potential risks and complications, including:

  • Arrhythmias: The procedure can cause abnormal heart rhythms, which may require treatment.
  • Bleeding or hematoma at the catheter insertion site
  • Damage to surrounding structures in the heart
  • Heart attack or stroke, though rare
  • Infection

 

Typical recovery time

The recovery period after septal reduction therapy varies depending on the type of procedure and individual healing. Most patients can resume normal activities within several weeks to months.

 

Results and post procedure care

Septal reduction therapy can lead to significant improvement in symptoms and heart function in many patients with HCM. However, individual results may vary, and long-term follow-up is necessary to evaluate the effectiveness of the therapy.

Following septal reduction therapy, you may be advised to:

  • Take prescribed medications, such as antibiotics or anti-inflammatory drugs, as directed.
  • Follow up with your healthcare provider for further evaluation and management of the underlying condition.
  • Monitor for any signs of complications, such as increased pain, swelling, redness, fever, or difficulty breathing, and promptly report them to your healthcare provider.