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type=\u0022text\/css\u0022 rel=\u0022stylesheet\u0022 href=\u0022\/\/d282kpwvnogo5m.cloudfront.net\/sites\/default\/files\/cdn\/css\/http\/css_Xg7z6oCTVgud_Q0huYz9x9iiD5H_2YPSJ5z2ZViSWdY.css\u0022 media=\u0022all\u0022 \/\u003E\n\u003Clink rel=\u0027stylesheet\u0027 type=\u0027text\/css\u0027 href=\u0027\/sites\/all\/modules\/contrib\/panels\/plugins\/layouts\/onecol\/onecol.css\u0027 \/\u003E\u003C\/head\u003E\u003Cbody\u003E\u003Cdiv class=\u0022panels-ajax-tab-panel panels-ajax-tab-panel-sageoa-tab-art\u0022\u003E\u003Cdiv class=\u0022panel-display panel-1col clearfix\u0022 \u003E\n  \u003Cdiv class=\u0022panel-panel panel-col\u0022\u003E\n    \u003Cdiv\u003E\u003Cdiv class=\u0022panel-pane pane-highwire-markup\u0022 \u003E\n  \n      \n  \n  \u003Cdiv class=\u0022pane-content\u0022\u003E\n    \u003Cdiv class=\u0022highwire-markup\u0022\u003E\u003Cdiv xmlns=\u0022http:\/\/www.w3.org\/1999\/xhtml\u0022 id=\u0022content-block-markup\u0022 xmlns:xhtml=\u0022http:\/\/www.w3.org\/1999\/xhtml\u0022\u003E\u003Cdiv class=\u0022article fulltext-view \u0022\u003E\u003Cspan class=\u0022highwire-journal-article-marker-start\u0022\u003E\u003C\/span\u003E\u003Cdiv class=\u0022section abstract\u0022 id=\u0022abstract-1\u0022\u003E\u003Ch2\u003ESummary\u003C\/h2\u003E\n            \u003Cp id=\u0022p-1\u0022\u003ECyanoacrylates are the main liquid adhesives used in the vascular system and have an important role in managing vascular abnormalities, especially arteriovenous malformations [Pollack JS, White RI, Jr. \u003Cem\u003EJ Vasc Interv Radiol\u003C\/em\u003E 2001]. This article discusses the use of glue septal ablation treatment for hypertrophic obstructive cardiomyopathy.\u003C\/p\u003E\n         \u003C\/div\u003E\u003Cul class=\u0022kwd-group\u0022\u003E\u003Cli class=\u0022kwd\u0022\u003EInflammatory Disease\u003C\/li\u003E\u003Cli class=\u0022kwd\u0022\u003ECardiology\u003C\/li\u003E\u003C\/ul\u003E\u003Cp id=\u0022p-2\u0022\u003ECyanoacrylates are the main liquid adhesives used in the vascular system and have an important role in managing vascular abnormalities, especially arteriovenous malformations [Pollack JS, White RI, Jr. \u003Cem\u003EJ Vasc Interv Radiol\u003C\/em\u003E 2001]. Ali Oto, MD, Hacettepe University, Ankara, Turkey, discussed the use of glue septal ablation (GSA) treatment for hypertrophic obstructive cardiomyopathy (HOCM).\u003C\/p\u003E\u003Cp id=\u0022p-3\u0022\u003EHOCM is characterized by asymmetric myocardial hypertrophy that is most pronounced in the interventricular septum and is responsible for the dynamic obstruction of the left ventricular outflow tract (LVOT) [Fifer MA et al. \u003Cem\u003ECirculation\u003C\/em\u003E 2008]. Prof. Oto explained that LVOT obstruction is due to the hypertrophied septum and mitral regurgitation.\u003C\/p\u003E\u003Cp id=\u0022p-4\u0022\u003EAlcohol septal ablation (ASA) for HOCM is a less invasive alternative to surgical myectomy to reduce the LVOT gradient in patients resistant to drug therapy [Alam M et al. \u003Cem\u003EEur Heart J\u003C\/em\u003E 2009]. A recent assessment of the technique found that a significant decrease in mean peak gradient (p\u0026lt;0.0001) in the LVOT was associated with a decrease in LV mass (p=0.0006) and with regression of LV hypertrophy outside the scar after ASA [Timmer SA et al. \u003Cem\u003EAm J Physiol\u003C\/em\u003E 2011.\u003C\/p\u003E\u003Cp id=\u0022p-5\u0022\u003EAccording to Prof. Oto, limitations of the ASA led him and his colleagues to publish their first-in-man GSA case in an HOCM patient with extensive collaterals to the posterior descending coronary artery that precluded alcohol ablation [Oto A et al. \u003Cem\u003ECatheter Cardiovasc Interv\u003C\/em\u003E 2007].\u003C\/p\u003E\u003Cp id=\u0022p-6\u0022\u003ELast year, Prof. Oto and colleagues described an approach for septal ablation with glue in HOCM patients with collateral formation to the right coronary artery in whom ASA was contraindicated [Oto A et al. \u003Cem\u003EJ Interv Cardiol\u003C\/em\u003E 2011]. GSA was performed in 18 patients, 6 of whom had collateral branches to the RCA. The left coronary ostium was cannulated with 6F to 8F guiding catheter. The septal branch was cannulated with a 4F catheter and microcatheter, and then cyanoacrylate mixture was instilled into the septal artery. Immediate polymerization prevented leakage into the left anterior descending (LAD) coronary artery, and also into the RCA via septal collaterals.\u003C\/p\u003E\u003Cp id=\u0022p-7\u0022\u003EImmediately after the procedure, peak LVOT gradient reduced significantly in both cardiac catheterization (65.0\u00b113.8 vs 14.2\u00b15.7 mm Hg; p\u0026lt;0.001) and Doppler echocardiographic measurements (75.8\u00b119.9 vs 18.0\u00b19.1 mm Hg; p\u0026lt;0.001; \u003Ca id=\u0022xref-fig-1-1\u0022 class=\u0022xref-fig\u0022 href=\u0022#F1\u0022\u003EFigure 1\u003C\/a\u003E). Reduction in LVOT gradient persisted after 6 months of follow-up. Furthermore, septal wall thickness (20.2\u00b13.7 vs 16.5\u00b13.2 mm; p=0.003) significantly decreased while NYHA functional class improved (3.1\u00b10.4 vs 2.2\u00b10.3; p\u0026lt;0.001). No significant complications occurred during the procedure or within 6 months of follow-up [Oto A et al. \u003Cem\u003EJ Interv Cardiol\u003C\/em\u003E 2011].\u003C\/p\u003E\u003Cdiv id=\u0022F1\u0022 class=\u0022fig pos-float  odd\u0022\u003E\u003Cdiv class=\u0022highwire-figure\u0022\u003E\u003Cdiv class=\u0022fig-inline-img-wrapper\u0022\u003E\u003Cdiv class=\u0022fig-inline-img\u0022\u003E\u003Ca href=\u0022http:\/\/d282kpwvnogo5m.cloudfront.net\/content\/spmdc\/12\/8\/28\/F1.large.jpg?width=800\u0026amp;height=600\u0026amp;carousel=1\u0022 title=\u0022Left Ventricular Outflow Tract Gradient.\u0022 class=\u0022fragment-images colorbox-load\u0022 rel=\u0022gallery-fragment-images-2131367631\u0022 data-figure-caption=\u0022Left Ventricular Outflow Tract Gradient.\u0022 data-icon-position=\u0022\u0022 data-hide-link-title=\u00220\u0022\u003E\u003Cimg class=\u0022fragment-image\u0022 alt=\u0022Figure 1.\u0022 src=\u0022http:\/\/d282kpwvnogo5m.cloudfront.net\/content\/spmdc\/12\/8\/28\/F1.medium.gif\u0022\/\u003E\u003C\/a\u003E\u003C\/div\u003E\u003C\/div\u003E\u003Cul class=\u0022highwire-figure-links inline\u0022\u003E\u003Cli class=\u00220 first\u0022\u003E\u003Ca href=\u0022http:\/\/d282kpwvnogo5m.cloudfront.net\/content\/spmdc\/12\/8\/28\/F1.large.jpg?download=true\u0022 class=\u0022highwire-figure-link highwire-figure-link-download\u0022 title=\u0022Download Figure 1.\u0022 data-icon-position=\u0022\u0022 data-hide-link-title=\u00220\u0022\u003EDownload figure\u003C\/a\u003E\u003C\/li\u003E\u003Cli class=\u00221\u0022\u003E\u003Ca href=\u0022http:\/\/d282kpwvnogo5m.cloudfront.net\/content\/spmdc\/12\/8\/28\/F1.large.jpg\u0022 class=\u0022highwire-figure-link highwire-figure-link-newtab\u0022 target=\u0022_blank\u0022 data-icon-position=\u0022\u0022 data-hide-link-title=\u00220\u0022\u003EOpen in new tab\u003C\/a\u003E\u003C\/li\u003E\u003Cli class=\u00222 last\u0022\u003E\u003Ca href=\u0022\/highwire\/powerpoint\/12778\u0022 class=\u0022highwire-figure-link highwire-figure-link-ppt\u0022 data-icon-position=\u0022\u0022 data-hide-link-title=\u00220\u0022\u003EDownload powerpoint\u003C\/a\u003E\u003C\/li\u003E\u003C\/ul\u003E\u003C\/div\u003E\u003Cdiv class=\u0022fig-caption\u0022 xmlns:xhtml=\u0022http:\/\/www.w3.org\/1999\/xhtml\u0022\u003E\u003Cspan class=\u0022fig-label\u0022\u003EFigure 1.\u003C\/span\u003E \n            \u003Cp id=\u0022p-8\u0022 class=\u0022first-child\u0022\u003ELeft Ventricular Outflow Tract Gradient.\u003C\/p\u003E\n         \u003Cdiv class=\u0022sb-div caption-clear\u0022\u003E\u003C\/div\u003E\u003C\/div\u003E\u003C\/div\u003E\u003Cp id=\u0022p-9\u0022\u003EProf. Oto and colleagues concluded that GSA is a promising alternative for treating patients with HOCM. Their experience suggests that GSA is safe, effective, and can be performed without serious complications.\u003C\/p\u003E\u003Cp id=\u0022p-10\u0022\u003EGlue seems to be superior to alcohol; immediate freezing prevents leakage to the LAD coronary artery and is thought to be particularly useful in the presence of collaterals. Further experience is needed to assess the long-term efficacy and safety of the technique.\u003C\/p\u003E\u003Cul class=\u0022copyright-statement\u0022\u003E\u003Cli class=\u0022fn\u0022 id=\u0022copyright-statement-1\u0022\u003E\u00a9 2012 MD Conference Express\u00ae\u003C\/li\u003E\u003C\/ul\u003E\u003Cspan class=\u0022highwire-journal-article-marker-end\u0022\u003E\u003C\/span\u003E\u003C\/div\u003E\u003Cspan id=\u0022related-urls\u0022\u003E\u003C\/span\u003E\u003C\/div\u003E\u003Ca href=\u0022http:\/\/mdc.sagepub.com\/content\/12\/8\/28.abstract\u0022 class=\u0022hw-link hw-link-article-abstract\u0022 data-icon-position=\u0022\u0022 data-hide-link-title=\u00220\u0022\u003EView Summary\u003C\/a\u003E\u003C\/div\u003E  \u003C\/div\u003E\n\n  \n  \u003C\/div\u003E\n\u003C\/div\u003E\n  \u003C\/div\u003E\n\u003C\/div\u003E\n\u003C\/div\u003E\u003Cscript type=\u0022text\/javascript\u0022 src=\u0022http:\/\/mdc.sagepub.com\/sites\/all\/modules\/highwire\/highwire\/plugins\/highwire_markup_process\/js\/highwire_figures.js?nznat1\u0022\u003E\u003C\/script\u003E\n\u003Cscript type=\u0022text\/javascript\u0022 src=\u0022http:\/\/mdc.sagepub.com\/sites\/all\/modules\/highwire\/highwire\/plugins\/highwire_markup_process\/js\/highwire_openurl.js?nznat1\u0022\u003E\u003C\/script\u003E\n\u003C\/body\u003E\u003C\/html\u003E"}