<HTML><BODY style="word-wrap: break-word; -khtml-nbsp-mode: space; -khtml-line-break: after-white-space; "><DIV style="margin-top: 0px; margin-right: 0px; margin-bottom: 0px; margin-left: 0px; "><FONT class="Apple-style-span" face="Arial">Dear Organizers of the Symposium,</FONT></DIV><DIV style="margin-top: 0px; margin-right: 0px; margin-bottom: 0px; margin-left: 0px; font: normal normal normal 13px/normal Lucida Grande; min-height: 16px; "><FONT class="Apple-style-span" face="Arial" size="3"><SPAN class="Apple-style-span" style="font-size: 12px;"><BR></SPAN></FONT></DIV><DIV style="margin-top: 0px; margin-right: 0px; margin-bottom: 0px; margin-left: 0px; "><FONT class="Apple-style-span" face="Arial">Thank you very much for this extraordinary Symposium!!!</FONT></DIV><DIV style="margin-top: 0px; margin-right: 0px; margin-bottom: 0px; margin-left: 0px; font: normal normal normal 13px/normal Lucida Grande; min-height: 16px; "><FONT class="Apple-style-span" face="Arial" size="3"><SPAN class="Apple-style-span" style="font-size: 12px;"><BR></SPAN></FONT></DIV><DIV style="margin-top: 0px; margin-right: 0px; margin-bottom: 0px; margin-left: 0px; "><FONT class="Apple-style-span" face="Arial">I was very impressed with the HCM cases. </FONT></DIV><DIV style="margin-top: 0px; margin-right: 0px; margin-bottom: 0px; margin-left: 0px; font: normal normal normal 13px/normal GB18030 Bitmap; min-height: 17px; "><FONT class="Apple-style-span" face="Arial" size="3"><SPAN class="Apple-style-span" style="font-size: 12px;"><BR></SPAN></FONT></DIV><DIV style="margin-top: 0px; margin-right: 0px; margin-bottom: 0px; margin-left: 0px; "><FONT class="Apple-style-span" face="Arial">I work since 1998 with patients carriers of obstructive HCM, very symptomatic. We perform septal ablation by alcohol on them (already 37 patients).</FONT></DIV><DIV style="margin-top: 0px; margin-right: 0px; margin-bottom: 0px; margin-left: 0px; font: normal normal normal 13px/normal Lucida Grande; min-height: 16px; "><FONT class="Apple-style-span" face="Arial" size="3"><SPAN class="Apple-style-span" style="font-size: 12px;"><BR></SPAN></FONT></DIV><DIV style="margin-top: 0px; margin-right: 0px; margin-bottom: 0px; margin-left: 0px; "><FONT class="Apple-style-span" face="Arial">In the histories they describe, no patient had echo stress to determine if significant gradient appears with stress, if there is hypotension with strain. Often times it is difficult for them to articulate their symptoms, and when asked, we see that they are virtually invalid; they hardly leave their houses. They don't walk; well, they live in a secluded way. We only have one patient with ICD and it never shocked. </FONT></DIV><DIV style="margin-top: 0px; margin-right: 0px; margin-bottom: 0px; margin-left: 0px; font: normal normal normal 13px/normal GB18030 Bitmap; min-height: 17px; "><FONT class="Apple-style-span" face="Arial" size="3"><SPAN class="Apple-style-span" style="font-size: 12px;"><BR></SPAN></FONT></DIV><DIV style="margin-top: 0px; margin-right: 0px; margin-bottom: 0px; margin-left: 0px; "><FONT class="Apple-style-span" face="Arial">The symptoms only improved after the obstruction was removed, and pulmonary hypertension disappeared when we decompressed the atrium. </FONT></DIV><DIV style="margin-top: 0px; margin-right: 0px; margin-bottom: 0px; margin-left: 0px; font: normal normal normal 13px/normal GB18030 Bitmap; min-height: 17px; "><FONT class="Apple-style-span" face="Arial" size="3"><SPAN class="Apple-style-span" style="font-size: 12px;"><BR></SPAN></FONT></DIV><DIV style="margin-top: 0px; margin-right: 0px; margin-bottom: 0px; margin-left: 0px; "><FONT class="Apple-style-span" face="Arial"> Silvia Judith Fortunato de Cano</FONT></DIV><FONT class="Apple-style-span" face="Arial"><BR></FONT><DIV> <SPAN class="Apple-style-span" style="border-collapse: separate; border-spacing: 0px 0px; color: rgb(0, 0, 0); font-family: Helvetica; font-size: 12px; font-style: normal; font-variant: normal; font-weight: normal; letter-spacing: normal; line-height: normal; text-align: auto; -khtml-text-decorations-in-effect: none; text-indent: 0px; -apple-text-size-adjust: auto; text-transform: none; orphans: 2; white-space: normal; widows: 2; word-spacing: 0px; "><DIV style="margin-top: 0px; margin-right: 0px; margin-bottom: 0px; margin-left: 0px; "><FONT class="Apple-style-span" face="Arial">--</FONT></DIV><DIV style="margin-top: 0px; margin-right: 0px; margin-bottom: 0px; margin-left: 0px; "><FONT class="Apple-style-span" face="Arial">Dr.</FONT><SPAN class="Apple-converted-space"><FONT class="Apple-style-span" face="Arial"> </FONT></SPAN><FONT class="Apple-style-span" face="Arial">Sergio</FONT><SPAN class="Apple-converted-space"><FONT class="Apple-style-span" face="Arial"> </FONT></SPAN><FONT class="Apple-style-span" face="Arial">Dubner</FONT></DIV><DIV style="margin-top: 0px; margin-right: 0px; margin-bottom: 0px; margin-left: 0px; "><FONT class="Apple-style-span" face="Arial">President</FONT><SPAN class="Apple-converted-space"><FONT class="Apple-style-span" face="Arial"> </FONT></SPAN><FONT class="Apple-style-span" face="Arial">of</FONT><SPAN class="Apple-converted-space"><FONT class="Apple-style-span" face="Arial"> </FONT></SPAN><FONT class="Apple-style-span" face="Arial">Scientific</FONT><SPAN class="Apple-converted-space"><FONT class="Apple-style-span" face="Arial"> </FONT></SPAN><FONT class="Apple-style-span" face="Arial">Committee</FONT></DIV><DIV style="margin-top: 0px; margin-right: 0px; margin-bottom: 0px; margin-left: 0px; font: normal normal normal 13px/normal Lucida Grande; min-height: 16px; ; font-family: Lucida Grande; font-size: 13px; "><FONT class="Apple-style-span" face="Arial" size="3"><SPAN class="Apple-style-span" style="font-size: 12px;"><BR style="font-family: Lucida Grande; font-size: 13px; "></SPAN></FONT></DIV><DIV style="margin-top: 0px; margin-right: 0px; margin-bottom: 0px; margin-left: 0px; "><FONT class="Apple-style-span" face="Arial">Dr.</FONT><SPAN class="Apple-converted-space"><FONT class="Apple-style-span" face="Arial"> </FONT></SPAN><FONT class="Apple-style-span" face="Arial">Edgardo</FONT><SPAN class="Apple-converted-space"><FONT class="Apple-style-span" face="Arial"> </FONT></SPAN><FONT class="Apple-style-span" face="Arial">Schapachnik</FONT></DIV><DIV style="margin-top: 0px; margin-right: 0px; margin-bottom: 0px; margin-left: 0px; "><FONT class="Apple-style-span" face="Arial">President</FONT><SPAN class="Apple-converted-space"><FONT class="Apple-style-span" face="Arial"> </FONT></SPAN><FONT class="Apple-style-span" face="Arial">of</FONT><SPAN class="Apple-converted-space"><FONT class="Apple-style-span" face="Arial"> </FONT></SPAN><FONT class="Apple-style-span" face="Arial">Steering</FONT><SPAN class="Apple-converted-space"><FONT class="Apple-style-span" face="Arial"> </FONT></SPAN><FONT class="Apple-style-span" face="Arial">Committee</FONT></DIV><FONT class="Apple-style-span" face="Arial"><BR class="Apple-interchange-newline"></FONT></SPAN><FONT class="Apple-style-span" face="Arial"> </FONT></DIV><DIV><BR class="khtml-block-placeholder"></DIV><FONT class="Apple-style-span" face="Arial"></FONT><DIV><BLOCKQUOTE type="cite"><P style="margin: 0.0px 0.0px 12.0px 0.0px"><FONT class="Apple-style-span" face="Arial">I write to you to introduce a clinical case. This patient is a 30 year old woman, with a family history of non obstructive HCM with genetic study that found a mutation in the Troponin T gene (TNT) located in chromosome 1. The mutation is Arg92Gln. Four cousins under 20 have suffered sudden death and one 45 year old aunt has also suffered sudden death. Her mother and 3 other cousins have a CDI because of the family history and evident HCM in Echo. Another aunt and one cousin also have a CDI because syncope and evident HCM.</FONT></P><P style="margin: 0.0px 0.0px 12.0px 0.0px"><FONT class="Apple-style-span" face="Arial">Currently this patient has not presented symptoms and the EKG shows a negative T wave in V1-V3 ( not present years ago), and the previously normal Echo has changed, and now shows a mild enlargement of left atrium and mild mid septum thickening of 12- 13 mm, with no abnormal aspect and no obstruction. MRI is similar to the Echo, and shows normal aspect of septum but thickness is 13mm. No arrhythmias during 24 hrs Holter nor exercise testing.</FONT></P><P style="margin: 0.0px 0.0px 12.0px 0.0px"><FONT class="Apple-style-span" face="Arial">She is on atenolol but we would like to have your input in this case on whether this justifies a CDI now.</FONT></P><P style="margin: 0.0px 0.0px 12.0px 0.0px"><FONT class="Apple-style-span" face="Arial">Besides, we would like to know your opinion about young members of this family. There are children and young persons with apparently normal Echo but they have one or two brothers with sudden death or syncope. ¿Do you think they also need a CDI? Finally, what about the adult and older members of this family? Probably most have an evident HCM in Echo. Would it be enough with atenolol or with amiodarore alone, or do they also need a CDI?. </FONT></P><P style="margin: 0.0px 0.0px 12.0px 0.0px"><FONT class="Apple-style-span" face="Arial">We appreciate and thank you for your time and suggestions. </FONT></P><P style="margin: 0.0px 0.0px 12.0px 0.0px"><FONT class="Apple-style-span" face="Arial">Most Sincerely </FONT></P><P style="margin: 0.0px 0.0px 12.0px 0.0px"><FONT class="Apple-style-span" face="Arial">Rene Asenjo <</FONT><A href="mailto:reneasenjo@vtr.net"><FONT class="Apple-style-span" face="Arial">reneasenjo@vtr.net</FONT></A><FONT class="Apple-style-span" face="Arial">></FONT></P></BLOCKQUOTE></DIV></BODY></HTML>