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Coexisting idiopathic hypertrophic subaortic stenosis and coronary artery disease. Clinical implication and operative
Insights
Coronary artery disease (CAD) and idiopathic hypertrophic subaortic stenosis (IHSS) can coexist, causing angina. Simultaneous surgical treatment of both conditions in three patients led to significant symptom relief.
Area of Science:
- Cardiology
- Cardiovascular Surgery
Background:
- Angina is a common symptom in patients with coronary artery disease (CAD) or idiopathic hypertrophic subaortic stenosis (IHSS).
- Coexistence of CAD and IHSS is reported in 25% of IHSS patients over 45.
- Failure to address both conditions during treatment can result in persistent symptoms.
Purpose of the Study:
- To highlight the importance of evaluating for both CAD and IHSS in patients presenting with angina.
- To present a surgical approach for patients with coexisting CAD and severe IHSS.
Main Methods:
- Case series of three patients with both CAD and severe IHSS.
- Surgical management involved septal myectomy and coronary artery revascularization.
Main Results:
- All three patients experienced significant symptomatic improvement after combined surgical intervention.
- Combined septal myectomy and coronary artery revascularization effectively managed coexisting CAD and IHSS.
Conclusions:
- Simultaneous surgical treatment of CAD and IHSS is a viable option for patients with both conditions.
- Comprehensive evaluation and treatment are crucial for symptomatic relief in patients with combined cardiac pathologies.
Abstract:
Patients with either coronary artery disease (CAD) or idiopathic hypertrophic subaortic stenosis (IHSS) may have angina as a dominant symptom. It is also possible that these two diseases may coexist in the same patient. Such an association has been reported in 25% of patients with IHSS who are over 45 years of age. It is important that both entities be looked for in the evaluation of the patient with angina, particularly when operative management is contemplated. Treatment of one and not the other may leave the patient symptomatic. We have encountered three patients with both CAD and severe IHSS and have managed each with septal myectomy and coronary artery revascularization. Each has obtained significant symptomatic improvement.