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Precision management of severe coronary artery calcification with concomitant left ventricular outflow tract
Wei Qi1,2, Yazheng Zhang3,4, Zhenzhen Wang5
1Department of Cardiology, Tianjin Chest Hospital, Tianjin, China.
Insights
Severe coronary artery calcification with hypertrophic cardiomyopathy and outflow tract obstruction is challenging. Multimodal management effectively relieved symptoms and obstruction in a complex case.
Area of Science:
- Cardiology
- Interventional Cardiology
- Cardiovascular Imaging
Background:
- Severe coronary artery calcification (CAC) poses diagnostic and therapeutic challenges, especially when combined with hypertrophic cardiomyopathy (HCM) and left ventricular outflow tract obstruction (LVOTO).
- This case highlights the complexity of managing patients with coexisting severe CAC, HCM, and dynamic LVOTO.
Background:
Severe coronary artery calcification (CAC) with hypertrophic cardiomyopathy (HCM) and left ventricular outflow tract obstruction (LVOTO) present complex diagnostic and therapeutic challenges.
Case Presentation:
A 72-year-old man with exertional chest pain and dyspnea exhibited multivessel CAC (total score; 1,696), asymmetric septal hypertrophy, and dynamic LVOTO. Percutaneous coronary intervention (PCI) was performed on the right coronary artery (RCA) and left circumflex artery (LCX) guided by quantitative flow ratio (QFR) and intravascular ultrasound (IVUS). Left anterior descending artery (LAD) lesions showed preserved function but microvascular dysfunction; no intervention was performed. Cardiac magnetic resonance imaging confirmed HCM with segmental fibrosis and LVOTO.
Intervention And Outcome:
Post-PCI, dual antiplatelet therapy was administered for 6 months, followed by aspirin monotherapy and oral mavacam (2.5 mg daily. After 4 months, the LVOT gradient decreased from 51 mmHg to 9-12 mmHg, with symptom resolution.
Conclusion:
Multimodal management combining coronary physiology, intravascular imaging, and targeted pharmacotherapy effectively relieved myocardial ischemia and LVOTO, thereby providing a reference for complex cases.
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