Discount treatment for HOCM: as good as surgery?

This editorial refers to ‘Long-term clinical outcome after alcohol septal ablation for obstructive hypertrophic cardiomyopathy: results from the Euro-ASA registry’[†][1], by J. Veselka et al ., on page 1517. At a recent cardiology meeting in Geneva, one of my former colleagues quoted a remark I had made in the early 1980s during a heart-team meeting on hypertrophic obstructive cardiomyopathy (HOCM) at the University of Lausanne: ‘Wouldn't it be much cheaper and less traumatic for the patient to create an infarct at the site of the septal bulge rather than opening the chest and removing the obstructive myocardium?’ Figure 1 The result of alcohol septal ablation (ASA) depends entirely on the variable blood supply and its proper identification. Meticulous planning is essential to the success. This remark was based on the observation we had made earlier that short balloon inflations inside the major proximal septal artery resulted in disappearance of the intraventricular pressure gradient in patients with symptomatic HOCM. More than 30 years ago, the time was not right for such a daring intervention. The project lay dormant until I made the same remark at the Royal Brompton Hospital grand rounds in London ∼10 years later. It was a senior pathologist, Bob Anderson, who, after brief reflection, replied: ‘Sounds logical, why don't you do it?’ This time, in … [1]: #fn-2