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Hypertrophic Obstructive Cardiomyopathy with SAM Phenomenon: A Case Report and Literature Review

Mei-Lian Cai1,2, Guo-Qiang Zhong1

  • 1Department of Cardiology, the First Affiliated Hospital of Guangxi Medical University, Nanning City, China.

Cardiology and Cardiovascular Medicine
|December 30, 2022
PubMed

Insights

Alcohol septal ablation effectively treated hypertrophic obstructive cardiomyopathy (HOCM) with systolic anterior motion (SAM) in a patient, relieving symptoms. This procedure, performed with a permanent pacemaker, offers a beneficial therapeutic option for HOCM patients.

Area of Science:

  • Cardiology
  • Genetics
  • Medical Imaging

Background:

  • Hypertrophic cardiomyopathy (HCM) is a genetic myocardial disease characterized by left ventricular hypertrophy (LVH).
  • HCM is the most common genetic abnormality of the myocardium, with prevalence from 1:500 to 1:200.
  • It is a leading cause of sudden cardiac death (SCD) in young individuals and athletes.

Purpose of the Study:

  • To present a case of hypertrophic obstructive cardiomyopathy (HOCM) with systolic anterior motion (SAM).
  • To evaluate the efficacy of alcohol septal ablation (ASA) in treating HOCM with SAM.
  • To assess the role of a permanent pacemaker in conjunction with ASA.

Main Methods:

  • A 56-year-old male patient presented with exertional chest tightness and palpitations.
  • Diagnostic workup included echocardiography, cardiac magnetic resonance (CMR), coronary angiography (CAG), and left ventriculography.
  • Treatment involved alcohol septal ablation (ASA) under the protection of a permanent pacemaker.

Main Results:

  • Echocardiography revealed significant interventricular septal thickness (14-16 mm) and mitral valve SAM.
  • The patient experienced severe left ventricular outflow tract (LVOT) stenosis and moderate to severe mitral insufficiency.
  • Following ASA and pacemaker implantation, the patient's symptoms of chest tightness and palpitations resolved.

Conclusions:

  • Alcohol septal ablation (ASA) is a beneficial treatment for patients with hypertrophic obstructive cardiomyopathy (HOCM) and systolic anterior motion (SAM).
  • The use of a permanent pacemaker provides protection during ASA.
  • This combined approach effectively resolved symptoms in the presented case.
Abstract

Keywords:
Alcohol Septal AblationHypertrophic CardiomyopathyHypertrophic Obstructive CardiomyopathySystolic Anterior Motion Phenomenon

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