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Alcohol septal ablation in patients with concomitant hypertrophic cardiomyopathy and aortic valvular stenosis

Bassim El-Sabawi1, Rick A Nishimura2, Mayra E Guerrero2

  • 1Department of Medicine, Mayo Clinic, Rochester, Minnesota.

Catheterization and Cardiovascular Interventions : Official Journal of the Society for Cardiac Angiography & Interventions
|August 15, 2019
PubMed

Insights

Percutaneous alcohol septal ablation effectively reduces dynamic left ventricular outflow tract obstruction in patients with hypertrophic cardiomyopathy and aortic stenosis. This minimally invasive procedure offers early symptom improvement for select patients.

Area of Science:

  • Cardiology
  • Interventional Cardiology
  • Cardiac Surgery

Background:

  • Alcohol septal ablation is established for hypertrophic cardiomyopathy-related dynamic left ventricular outflow tract (LVOT) obstruction.
  • The efficacy of this procedure in patients with coexisting aortic stenosis (AS) is not well-defined.

Observation:

  • A case series of six patients with severe dynamic LVOT obstruction and AS underwent alcohol septal ablation.
  • Patients presented with NYHA class III or greater symptoms.

Findings:

  • All patients successfully underwent alcohol septal ablation, achieving immediate reduction in the dynamic LVOT gradient.
  • A residual fixed obstruction due to AS persisted post-ablation.
  • At one-month follow-up, a majority of patients showed improvement in NYHA class.

Implications:

  • Alcohol septal ablation appears feasible for managing combined dynamic LVOT obstruction and AS.
  • Further research is needed to establish the optimal treatment strategy for this complex patient group.
Abstract

Keywords:
aortic valve diseasehemodynamicspercutaneous interventiontranscatheter valve implantation

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