Understanding the Management and Treatment of Obstruction in Hypertrophic Cardiomyopathy (HoCM)

Prof Perry Elliott, Dr Costas O'Mahony and Mr Alex Shipolini are hosted by Cardiomyopathy UK Trustee Libby Jarman to discuss the management and treatment of obstruction in hypertrophic cardiomyopathy (HCM / HoCM). Find out more at www.cardiomyopathy.org Chapters: Part 1 – Understanding hypertrophic obstructive cardiomyopathy 00:01:03 – What do we mean by ‘obstruction’ in hypertrophic cardiomyopathy (HCM)? 00:03:35 – How are the symptoms of HCM managed? 00:04:45 – What are the next steps in HCM following medication? 00:07:50 – What happens when medication is no-longer effective? 00:11:30 – Who makes the decision about whether surgery is appropriate? 00:14:30 – Do we know the prognostic value for surgical intervention? 00:15:30 – What causes the obstruction in HCM? 00:16:35 – Does the muscle in the heart get thicker over time? Part 2 – Septal myectomy in HCM 00:18:00 – What is a septal myectomy? 00:20:45 – Is septal myectomy only performed in ‘end-stage’ HCM? 00:23:10 – What are the eligibility criteria for septal myectomy? 00:24:25 – What are the risks of going on coronary bypass? 00:26:30 – What is ‘cell salvage’? 00:28:13 – Are there instant improvement in symptoms with myectomy? 00:29:00 – What does the follow-up to surgery involve? 00:29:45 – What are the practical considerations that should be made ahead of surgery? 00:34:30 – What are the longer-term outcomes of septal myectomy? 00:36:15 – Does the muscle grow back? 00:36:25 – Do people still need to be on medication following a septal myectomy? Part 3 – Alcohol Septal Ablation 00:38:05 – What is alcohol septal ablation? 00:41:00 – What are the pros and cons of alcohol septal ablation 00:42:50 – What is a pacemaker? 00:44:05 – Are there any candidates that are not suitable for alcohol septal ablation? 00:45:03 – Does the muscle grow back? 00:45:20 – Do patients need to continue medication following alcohol septal ablation? 00:46:11 – What is meant by the ‘gradient’? 00:47:15 – How does septal myectomy compare to alcohol septal ablation? 00:49:00 – Is it still possible to have a septal myectomy following alcohol septal ablation? 00:51:30 – What are the most important things to consider when comparing alcohol septal ablation versus septal myectomy? 00:52:30 – What are the prognostic differences between septal myectomy and alcohol septal ablation? 00:55:10 – Conclusions Part 4 – The Role of Mavacamten and Aficamten in HCM 00:55:30 – What is Mavacamten and how does it work? 01:00:05 – How will Mavacamten impact surgical intervention options in HCM? 01:02:10 – Will Mavacamten speed up the route to surgery in HCM? 01:04:15 – Will people who have had surgical interventions benefit from Mavacamten? 01:05:20 – How does Mavacamten impact the journey of HCM? 01:07:45 – Is Mavacamten only for people with obstruction, or could it work for people with non-obstructive HCM? 011:09:23 – Conclusions For more information visit www.cardiomyopathy.org