<?xml version="1.0" encoding="ISO-8859-1"?><article xmlns:mml="http://www.w3.org/1998/Math/MathML" xmlns:xlink="http://www.w3.org/1999/xlink" xmlns:xsi="http://www.w3.org/2001/XMLSchema-instance">
<front>
<journal-meta>
<journal-id>1688-0420</journal-id>
<journal-title><![CDATA[Revista Uruguaya de Cardiología]]></journal-title>
<abbrev-journal-title><![CDATA[Rev.Urug.Cardiol.]]></abbrev-journal-title>
<issn>1688-0420</issn>
<publisher>
<publisher-name><![CDATA[Sociedad Uruguaya de Cardiología]]></publisher-name>
</publisher>
</journal-meta>
<article-meta>
<article-id>S1688-04202020000100290</article-id>
<article-id pub-id-type="doi">10.29277/cardio.35.1.15</article-id>
<title-group>
<article-title xml:lang="es"><![CDATA[Miocardiopatía hipertrófica: encare clínico y opciones de tratamiento]]></article-title>
<article-title xml:lang="en"><![CDATA[Hypertrophic cardiomyopathy: clinical approach and treatment options]]></article-title>
<article-title xml:lang="pt"><![CDATA[Cardiomiopatia hipertrófica: abordagem clínica e opções de tratamento]]></article-title>
</title-group>
<aff id="A">
<institution><![CDATA[,  ]]></institution>
<addr-line><![CDATA[ ]]></addr-line>
</aff>
<pub-date pub-type="pub">
<day>00</day>
<month>00</month>
<year>2020</year>
</pub-date>
<pub-date pub-type="epub">
<day>00</day>
<month>00</month>
<year>2020</year>
</pub-date>
<volume>35</volume>
<numero>1</numero>
<fpage>290</fpage>
<lpage>348</lpage>
<copyright-statement/>
<copyright-year/>
<self-uri xlink:href="http://www.scielo.edu.uy/scielo.php?script=sci_arttext&amp;pid=S1688-04202020000100290&amp;lng=en&amp;nrm=iso"></self-uri><self-uri xlink:href="http://www.scielo.edu.uy/scielo.php?script=sci_abstract&amp;pid=S1688-04202020000100290&amp;lng=en&amp;nrm=iso"></self-uri><self-uri xlink:href="http://www.scielo.edu.uy/scielo.php?script=sci_pdf&amp;pid=S1688-04202020000100290&amp;lng=en&amp;nrm=iso"></self-uri><abstract abstract-type="short" xml:lang="es"><p><![CDATA[Resumen: La miocardiopatía hipertrófica (MCH) constituye una enfermedad compleja y muy variable en cuanto a su presentación morfológica, fisiopatológica y sintomática, así como en su pronóstico. Su intrincado sustrato genético ha sido objeto de una permanente y productiva investigación en las últimas décadas. En correspondencia con esta complejidad, su manejo clínico representa un desafío, aun para los cardiólogos más experimentados. La presente controversia comienza con una valiosa actualización por parte del Dr. Walter Reyes sobre la valoración del riesgo individual de muerte súbita en el paciente portador de esta patología, sin duda el más temido evento que pueda presentarse durante su transcurso. En este abordaje se podrá apreciar la evolución de los conceptos, desde la aplicación de los clásicos factores de riesgo obtenidos de los primeros estudios en poblaciones más o menos seleccionadas, hasta las recomendaciones más recientes de la American Heart Association y la European Society of Cardiology, capitalizando la nueva información. Luego, como es habitual y dado el objetivo esencialmente práctico de esta sección, se propone una viñeta sobre un caso de MCH obstructiva en la que el autor aplica, a forma de ejercicio clínico, la información brindada en la revisión previa. A continuación se plantea la controversia propiamente dicha, donde el debate se centra en la elección de la técnica más apropiada de reducción septal en el caso propuesto, cuyas características apuntan a la necesidad de un abordaje invasivo. Dos prestigiosos invitados exponen sus argumentos en favor de cada alternativa. El Dr. Hartzell Shaff propone la miectomía septal quirúrgica como el procedimiento más adecuado, y el Dr. Pedro Trujillo plantea la ablación septal percutánea como solución de elección. El desarrollo de ambas exposiciones permitirá al lector apreciar la importancia de un enfoque individualizado, dada la riqueza de información clínica, anatomofuncional y propia de cada procedimiento que se requiere para inclinar la balanza en favor de uno u otro. Ambos autores coinciden en el beneficio de contar con un equipo especializado y experimentado para la obtención de buenos resultados con cualquiera de las técnicas.]]></p></abstract>
<abstract abstract-type="short" xml:lang="en"><p><![CDATA[Summary: 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 clinical management 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 patient with this disease, without doubt the most feared event that may occur during its course. In this approach, evolution of concepts can be appreciated, from the 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 the most appropriate septal reduction technique. Two prestigious guests present their arguments in favour of each alternative. Prof. Hartzell Shaff proposes surgical septal myectomy as the most appropriate procedure, and Dr. Pedro Trujillo proposes percutaneous septal ablation as the solution of choice. The exposures will 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.]]></p></abstract>
<abstract abstract-type="short" xml:lang="pt"><p><![CDATA[Resumo: A cardiomiopatia hipertrófica é uma doença complexa e altamente variável em termos de apresentação morfológica, fisiopatológica e sintomática, bem como em seu prognóstico. Seu intrincado substrato genético tem sido objeto de pesquisa permanente nas últimas décadas. Correspondendo a essa complexidade, seu manejo clínico representa um desafio, mesmo para os cardiologistas mais experientes. A presente controvérsia começa com uma atualização valiosa do Dr. Walter Reyes sobre a avaliação do risco individual de morte súbita no paciente com esta doença, sem dúvida o evento mais temido que pode ocorrer durante seu curso. Nessa abordagem, a evolução dos conceitos pode ser apreciada, desde a aplicação dos fatores de risco clássicos obtidos nos primeiros estudos, até as recomendações mais recentes da American Heart Association e da European Society of Cardiology. Como o objetivo prático desta seção, é proposto um caso clínico em uma cardiomiopatia hipertrófica obstrutiva, no qual o autor aplica, como exercício clínico, as informações fornecidas na revisão anterior. Em seguida, surge a própria controvérsia, onde o debate se concentra na escolha da técnica de redução septal mais apropriada. Dois convidados de prestígio apresentam seus argumentos em favor de cada alternativa. O professor Hartzell Shaff propõe a miectomia septal cirúrgica como o procedimento mais apropriado e o Dr. Pedro Trujillo propõe a ablação septal percutânea como a solução de escolha. As exposições permitirão ao leitor apreciar a importância de uma abordagem individualizada, dada a quantidade de informações clínicas, anatômicas, funcionais e específicas de cada procedimento, necessárias para inclinar a balança em favor de uma ou de outra. Ambos os autores concordam com o benefício de ter uma equipe especializada e experiente para obter bons resultados com qualquer uma das técnicas.]]></p></abstract>
<kwd-group>
<kwd lng="es"><![CDATA[Cardiomiopatía hipertrófica]]></kwd>
<kwd lng="es"><![CDATA[Muerte súbita]]></kwd>
<kwd lng="es"><![CDATA[Terapias de reducción septal]]></kwd>
<kwd lng="es"><![CDATA[Ablación septal con alcohol]]></kwd>
<kwd lng="es"><![CDATA[Miectomía Septal]]></kwd>
<kwd lng="en"><![CDATA[Hypertrophic cardiomyopathy]]></kwd>
<kwd lng="en"><![CDATA[Sudden death]]></kwd>
<kwd lng="en"><![CDATA[Septal reduction therapies]]></kwd>
<kwd lng="en"><![CDATA[Alcohol septal ablation]]></kwd>
<kwd lng="en"><![CDATA[Septal myectomy]]></kwd>
<kwd lng="pt"><![CDATA[Cardiomiopatia hipertrófica]]></kwd>
<kwd lng="pt"><![CDATA[Morte súbita]]></kwd>
<kwd lng="pt"><![CDATA[Terapias de redução septal]]></kwd>
<kwd lng="pt"><![CDATA[Ablação septal com álcool]]></kwd>
<kwd lng="pt"><![CDATA[Miectomia septal]]></kwd>
</kwd-group>
</article-meta>
</front><back>
<ref-list>
<ref id="B1">
<label>1</label><nlm-citation citation-type="journal">
<person-group person-group-type="author">
<name>
<surname><![CDATA[Kimmelstiel]]></surname>
<given-names><![CDATA[C]]></given-names>
</name>
<name>
<surname><![CDATA[Zisa]]></surname>
<given-names><![CDATA[D]]></given-names>
</name>
<name>
<surname><![CDATA[Kuttab]]></surname>
<given-names><![CDATA[J]]></given-names>
</name>
<name>
<surname><![CDATA[Wells]]></surname>
<given-names><![CDATA[S]]></given-names>
</name>
<name>
<surname><![CDATA[Udelson]]></surname>
<given-names><![CDATA[J]]></given-names>
</name>
<name>
<surname><![CDATA[Wessler]]></surname>
<given-names><![CDATA[B]]></given-names>
</name>
</person-group>
<article-title xml:lang=""><![CDATA[Guideline-based referral for septal reduction therapy in obstructive hypertrophic cardiomyopathy is associated with excellent clinical outcomes]]></article-title>
<source><![CDATA[Circ Cardiovasc Interv]]></source>
<year>2019</year>
<volume>12</volume>
<numero>7</numero>
<issue>7</issue>
</nlm-citation>
</ref>
<ref id="B2">
<label>2</label><nlm-citation citation-type="journal">
<person-group person-group-type="author">
<name>
<surname><![CDATA[Khalpey]]></surname>
<given-names><![CDATA[Z]]></given-names>
</name>
<name>
<surname><![CDATA[Korovin]]></surname>
<given-names><![CDATA[L]]></given-names>
</name>
<name>
<surname><![CDATA[Chitwood WJr]]></surname>
</name>
<name>
<surname><![CDATA[Poston]]></surname>
<given-names><![CDATA[R]]></given-names>
</name>
</person-group>
<article-title xml:lang=""><![CDATA[Robot-assisted septal myectomy for hypertrophic cardiomyopathy with left ventricular outflow tract obstruction]]></article-title>
<source><![CDATA[J Thorac Cardiovasc Surg]]></source>
<year>2014</year>
<volume>147</volume>
<numero>5</numero>
<issue>5</issue>
<page-range>1708-9</page-range></nlm-citation>
</ref>
<ref id="B3">
<label>3</label><nlm-citation citation-type="journal">
<person-group person-group-type="author">
<name>
<surname><![CDATA[Chou]]></surname>
<given-names><![CDATA[N]]></given-names>
</name>
<name>
<surname><![CDATA[Okano]]></surname>
<given-names><![CDATA[R]]></given-names>
</name>
<name>
<surname><![CDATA[Tedoriya]]></surname>
<given-names><![CDATA[T]]></given-names>
</name>
<name>
<surname><![CDATA[Wu]]></surname>
<given-names><![CDATA[I]]></given-names>
</name>
<name>
<surname><![CDATA[Yu]]></surname>
<given-names><![CDATA[H]]></given-names>
</name>
<name>
<surname><![CDATA[Chen]]></surname>
<given-names><![CDATA[Y]]></given-names>
</name>
</person-group>
<article-title xml:lang=""><![CDATA[Robotic transmitral approach for hypertrophic cardiomyopathy with systolic anterior motion]]></article-title>
<source><![CDATA[Circ J]]></source>
<year>2018</year>
<volume>82</volume>
<numero>11</numero>
<issue>11</issue>
<page-range>2761-6</page-range></nlm-citation>
</ref>
<ref id="B4">
<label>4</label><nlm-citation citation-type="journal">
<person-group person-group-type="author">
<name>
<surname><![CDATA[Gilmanov]]></surname>
<given-names><![CDATA[D]]></given-names>
</name>
<name>
<surname><![CDATA[Bevilacqua]]></surname>
<given-names><![CDATA[S]]></given-names>
</name>
<name>
<surname><![CDATA[Solinas]]></surname>
<given-names><![CDATA[M]]></given-names>
</name>
<name>
<surname><![CDATA[Ferrarini]]></surname>
<given-names><![CDATA[M]]></given-names>
</name>
<name>
<surname><![CDATA[Kallushi]]></surname>
<given-names><![CDATA[E]]></given-names>
</name>
<name>
<surname><![CDATA[Santarelli]]></surname>
<given-names><![CDATA[P]]></given-names>
</name>
</person-group>
<article-title xml:lang=""><![CDATA[Minimally invasive septal myectomy for the treatment of hypertrophic obstructive cardiomyopathy and intrinsic mitral valve disease]]></article-title>
<source><![CDATA[Innovations (Phila)]]></source>
<year>2015</year>
<volume>10</volume>
<numero>2</numero>
<issue>2</issue>
<page-range>106-13</page-range></nlm-citation>
</ref>
<ref id="B5">
<label>5</label><nlm-citation citation-type="journal">
<person-group person-group-type="author">
<name>
<surname><![CDATA[Valeti]]></surname>
<given-names><![CDATA[U]]></given-names>
</name>
<name>
<surname><![CDATA[Nishimura]]></surname>
<given-names><![CDATA[R]]></given-names>
</name>
<name>
<surname><![CDATA[Holmes]]></surname>
<given-names><![CDATA[D]]></given-names>
</name>
<name>
<surname><![CDATA[Araoz]]></surname>
<given-names><![CDATA[P]]></given-names>
</name>
<name>
<surname><![CDATA[Glockner]]></surname>
<given-names><![CDATA[J]]></given-names>
</name>
<name>
<surname><![CDATA[Breen]]></surname>
<given-names><![CDATA[J]]></given-names>
</name>
</person-group>
<article-title xml:lang=""><![CDATA[Comparison of surgical septal myectomy and alcohol septal ablation with cardiac magnetic resonance imaging in patients with hypertrophic obstructive cardiomyopathy]]></article-title>
<source><![CDATA[J Am Coll Cardiol]]></source>
<year>2007</year>
<volume>49</volume>
<numero>3</numero>
<issue>3</issue>
<page-range>350-7</page-range></nlm-citation>
</ref>
<ref id="B6">
<label>6</label><nlm-citation citation-type="journal">
<person-group person-group-type="author">
<name>
<surname><![CDATA[Nguyen]]></surname>
<given-names><![CDATA[A]]></given-names>
</name>
<name>
<surname><![CDATA[Schaff]]></surname>
<given-names><![CDATA[H]]></given-names>
</name>
<name>
<surname><![CDATA[Hang]]></surname>
<given-names><![CDATA[D]]></given-names>
</name>
<name>
<surname><![CDATA[Nishimura]]></surname>
<given-names><![CDATA[R]]></given-names>
</name>
<name>
<surname><![CDATA[Geske]]></surname>
<given-names><![CDATA[J]]></given-names>
</name>
<name>
<surname><![CDATA[Dearani]]></surname>
<given-names><![CDATA[J]]></given-names>
</name>
</person-group>
<article-title xml:lang=""><![CDATA[Surgical myectomy versus alcohol septal ablation for obstructive hypertrophic cardiomyopathy a propensity score-matched cohort]]></article-title>
<source><![CDATA[J Thorac Cardiovasc Surg]]></source>
<year>2019</year>
<volume>157</volume>
<numero>1</numero>
<issue>1</issue>
<page-range>306-15</page-range></nlm-citation>
</ref>
<ref id="B7">
<label>7</label><nlm-citation citation-type="journal">
<person-group person-group-type="author">
<name>
<surname><![CDATA[Nguyen]]></surname>
<given-names><![CDATA[A]]></given-names>
</name>
<name>
<surname><![CDATA[Schaff]]></surname>
<given-names><![CDATA[H]]></given-names>
</name>
<name>
<surname><![CDATA[Nishimura]]></surname>
<given-names><![CDATA[R]]></given-names>
</name>
<name>
<surname><![CDATA[Dearani]]></surname>
<given-names><![CDATA[J]]></given-names>
</name>
<name>
<surname><![CDATA[Geske]]></surname>
<given-names><![CDATA[J]]></given-names>
</name>
<name>
<surname><![CDATA[Lahr]]></surname>
<given-names><![CDATA[B]]></given-names>
</name>
</person-group>
<article-title xml:lang=""><![CDATA[Does septal thickness influence outcome of myectomy for hypertrophic obstructive cardiomyopathy]]></article-title>
<source><![CDATA[Eur J Cardiothorac Surg]]></source>
<year>2018</year>
<volume>53</volume>
<numero>3</numero>
<issue>3</issue>
<page-range>582-9</page-range></nlm-citation>
</ref>
<ref id="B8">
<label>8</label><nlm-citation citation-type="journal">
<person-group person-group-type="author">
<name>
<surname><![CDATA[Batzner]]></surname>
<given-names><![CDATA[A]]></given-names>
</name>
<name>
<surname><![CDATA[Pfeiffer]]></surname>
<given-names><![CDATA[B]]></given-names>
</name>
<name>
<surname><![CDATA[Neugebauer]]></surname>
<given-names><![CDATA[A]]></given-names>
</name>
<name>
<surname><![CDATA[Aicha]]></surname>
<given-names><![CDATA[D]]></given-names>
</name>
<name>
<surname><![CDATA[Blank]]></surname>
<given-names><![CDATA[C]]></given-names>
</name>
<name>
<surname><![CDATA[Seggewiss]]></surname>
<given-names><![CDATA[H]]></given-names>
</name>
</person-group>
<article-title xml:lang=""><![CDATA[Survival after alcohol septal ablation in patients with hypertrophic obstructive cardiomyopathy]]></article-title>
<source><![CDATA[J Am Coll Cardiol]]></source>
<year>2018</year>
<volume>72</volume>
<numero>24</numero>
<issue>24</issue>
<page-range>3087-94</page-range></nlm-citation>
</ref>
<ref id="B9">
<label>9</label><nlm-citation citation-type="journal">
<person-group person-group-type="author">
<name>
<surname><![CDATA[Quintana]]></surname>
<given-names><![CDATA[E]]></given-names>
</name>
<name>
<surname><![CDATA[Sabate-Rotes]]></surname>
<given-names><![CDATA[A]]></given-names>
</name>
<name>
<surname><![CDATA[Maleszewski]]></surname>
<given-names><![CDATA[J]]></given-names>
</name>
<name>
<surname><![CDATA[Ommen]]></surname>
<given-names><![CDATA[S]]></given-names>
</name>
<name>
<surname><![CDATA[Nishimura]]></surname>
<given-names><![CDATA[R]]></given-names>
</name>
<name>
<surname><![CDATA[Dearani]]></surname>
<given-names><![CDATA[J]]></given-names>
</name>
</person-group>
<article-title xml:lang=""><![CDATA[Septal myectomy after failed alcohol ablation does previous percutaneous intervention compromise outcomes of myectomy?]]></article-title>
<source><![CDATA[J Thorac Cardiovasc Surg]]></source>
<year>2015</year>
<volume>150</volume>
<numero>1</numero>
<issue>1</issue>
<page-range>159-67</page-range></nlm-citation>
</ref>
<ref id="B10">
<label>10</label><nlm-citation citation-type="journal">
<person-group person-group-type="author">
<name>
<surname><![CDATA[Cui]]></surname>
<given-names><![CDATA[H]]></given-names>
</name>
<name>
<surname><![CDATA[Schaff]]></surname>
<given-names><![CDATA[H]]></given-names>
</name>
<name>
<surname><![CDATA[Nishimura]]></surname>
<given-names><![CDATA[R]]></given-names>
</name>
<name>
<surname><![CDATA[Geske]]></surname>
<given-names><![CDATA[J]]></given-names>
</name>
<name>
<surname><![CDATA[Dearani]]></surname>
<given-names><![CDATA[J]]></given-names>
</name>
<name>
<surname><![CDATA[Lahr]]></surname>
<given-names><![CDATA[B]]></given-names>
</name>
</person-group>
<article-title xml:lang=""><![CDATA[Conduction abnormalities and long-term mortality following septal myectomy in patients with obstructive hypertrophic cardiomyopathy]]></article-title>
<source><![CDATA[J Am Coll Cardiol]]></source>
<year>2019</year>
<volume>74</volume>
<numero>5</numero>
<issue>5</issue>
<page-range>645-55</page-range></nlm-citation>
</ref>
</ref-list>
</back>
</article>
