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Updated: Aug 16, 2025

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Published on: September 15, 2023
Effective treatment of hypertrophic cardiomyopathy with left ventricular outflow tract obstruction using a covered
Devon Pekas1, Adya Chawda2, Nayan Desai2
1School of Medicine and Health Sciences, University of North Dakota, Grand Forks, North Dakota, USA devon.pekas@und.edu.
Insights
A novel stenting technique successfully treated severe left ventricular outflow tract obstruction in a patient with hypertrophic cardiomyopathy. This intervention significantly improved the patient's exertional symptoms and reduced the obstruction gradient.
Area of Science:
- Cardiology
- Interventional Cardiology
- Cardiovascular Imaging
Background:
- Hypertrophic cardiomyopathy (HCM) can cause significant left ventricular outflow tract (LVOT) obstruction, leading to debilitating symptoms.
- Traditional treatments like alcohol septal ablation carry risks and may not always be feasible.
Abstract:
A woman in her 60s presented with progressive exertional dyspnoea, exertional chest pressure and exertional dizziness. Echocardiogram identified a 156 mm Hg left ventricular outflow tract gradient with provocation, indicating hypertrophic cardiomyopathy with left ventricular outflow obstruction-confirmed with MRI and angiogram. An alcohol septal ablation was planned but due to communication of the second septal perforator with the right ventricle and a wire-induced mid-left anterior descending artery dissection, alcohol septal ablation was not performed. Instead, a covered stent was placed in the mid-left anterior descending artery covering the origins of the third and fourth septal perforators. The left ventricular outflow tract gradient decreased from 90 to 30 mm Hg with provocation and her symptoms improved. Follow-up showed a left ventricular outflow tract gradient of 35 mm Hg with provocation and decreased symptoms.
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