Hypertrophic cardiomyopathy: clinical approach and treatment options

Abstract

Hypertrophic cardiomyopathy is a complex and highly variable disease in terms of morphological, pathophysiological and symptomatic presentation, as well as in its prognosis. Its intricate genetic substrate has been subject of permanent research in recent decades. Corresponding to this complexity, its clinicalmanagement represents a challenge, even for the most experienced cardiologists.
The present controversy begins with a valuable update by Dr. Walter Reyes about assessment of individual risk of sudden death in the patientwith this disease,without doubt themost feared event thatmay occur during its course. In this approach, evolution of concepts can be appreciated, fromthe application of the classic risk factors obtained from the first studies, to the most recent recommendations of the American Heart Association and the European Society of Cardiology.
Since the practical objective of this section, a clinical case is proposed on an obstructive hypertrophic cardiomyopathy in which the author applies, as a clinical exercise, the information provided in the previous review.
Next, the controversy itself arises, where the debate focuses on the choice of themost appropriate septal reduction technique.
Two prestigious guests present their arguments in favour of each alternative. Prof. Hartzell Shaff proposes surgical septal myectomy as themost appropriate procedure, and Dr. Pedro Trujillo proposes percutaneous septal ablation as the solution of choice.The exposureswill allow the reader to appreciate the importance of an individualized approach, given the amount of clinical, anatomic, functional and specific information of each procedure that is required to tip the balance in favour of one or the other. Both authors agree on the benefit of having a specialized and experienced team to obtain good results with any of the techniques.