Apr. 29, 1999 LOS ANGELES (April 28, 1999) - Los Angeles pharmacist Armando Figueroa was running low on optimism and options when he learned about a revolutionary, non-surgical investigational cardiac procedure available at Cedars-Sinai Medical Center. Armando suffered from hypertrophic obstructive cardiomyopathy, also known as IHSS (Idiopathic Hypertrophic Subaortic Stenosis), an overgrowth of muscle on the inside center wall of the heart that restricts the flow of blood from the heart. His symptoms --shortness of breath and chest pain - had become debilitating and, potentially, life-threatening.
"I could hardly function," recalled Armando, 60, who became too weak to work. "Just to go out to dinner was extremely difficult -- walking from the front door to the garage was a major effort. My quality of life was really going downhill."
In March, Armando became the first patient in Southern California to undergo this new procedure, called a septal ablation, which actually creates a "controlled" heart attack that destroys the excess heart muscle and helps relieve the obstruction to flow of blood from the heart. Almost a month later, Armando looks back with no regrets and newfound enthusiasm about the future.
"I'm enjoying my life again," Armando stated emphatically. "I was practically bed-ridden for six months, and now I'm looking forward to going back to work in May."
An estimated one in 500 people suffers from hypertrophic obstructive cardiomoypathy. Hypertrophy, or "thickening," refers to the overgrowth of muscle that restricts the flow of blood from the left ventricle of the heart to the aorta, often resulting in increasingly severe shortness of breath, chest pain, palpitations and dizziness.
"In the past, the only treatment options were medications and, if they became ineffective, open heart surgery to 'shave off' the obstruction," explained interventional cardiologist Raj Makkar, M.D., associate director of the Cardiovascular Intervention Center and co-director of the Interventional Cardiology Research Program in the Division of Cardiology at Cedars-Sinai.
For many patients, the decision to undergo surgery is a difficult one, given the inherent risks and lengthy recovery time. But it was the only option until Dr. Ulrich Sigwart, a Swiss physician now practicing in London, developed a radical new approach to treating hypertrophic cardiomyopathy about four years ago. Within the controlled setting of a hospital laboratory, pure alcohol is injected into an artery that flows into the thickened area of the heart. The alcohol "kills" the excess muscle, relieving the obstruction and allowing blood to flow freely once again. In the U.S., this procedure has been pioneered by a Houston cardiologist, Dr. William Spencer, over the last three years.
"It's a 'wow' kind of procedure," stated Dr. Makkar, who performed Armando's procedure. "As a cardiologist, you're trained to prevent, abort and treat heart attacks; to actually create a heart attack to help the patient is an unconventional concept. But the results are truly phenomenal."
Armando wholeheartedly attests to that fact. "My wife noticed immediately after the procedure that the color had come back to my face," he remembered. And there were even more dramatic results. "When I came in to the hospital, I was very weak and really couldn't walk," said Armando, who spent just two nights recovering at Cedars-Sinai. "Almost immediately, I could move around. I really feel excellent now, though I have to work at regaining my stamina after being inactive for so long.
"Though a relatively "simple" procedure, there are risks, Dr. Makkar pointed out. The toxicity of the alcohol could potentially produce unwanted damage to the surrounding heart tissue, which is why the alcohol is carefully administered utilizing catheters and ultrasound to confirm accurate delivery. Potential candidates for the procedure are carefully screened and apprised of possible risks. "While we are excited about the immediate and intermediate outcomes, we still need to learn more about the long-term consequences of the procedure," Dr. Makkar cautioned.
"Compared to open heart surgery, the approach seemed very easy and simple, but I understood the risks," said Armando. "I did some research on the Internet, and I felt confident once I spoke with the physicians. They were very professional and up front with me and supplied all the information necessary to make my decision."
Armando was conscious throughout the procedure and remembers only four or five minutes of chest discomfort, which is controlled by medication. "It wasn't excruciating," he added. "The whole process was so easy and quick -- I was in and out of the lab in about an hour and a half. It's amazing to have something done to your heart, and be home in a couple of days!"
Cedars-Sinai is one of approximately two dozen sites in the U.S. performing the procedure under an institutionally approved clinical research protocol, and data is being collected in a national registry to help assess the efficacy of the approach. "This information will help us increase our knowledge and, hopefully, feel comfortable recommending this procedure routinely in the future," added Dr. Makkar.
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