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Simultaneous percutaneous treatment in hypertrophic obstructive cardiomyopathy and coronary artery disease: a case
H Seggewiss1, L Faber, W Meyners
1Kardiologische Klinik, Herz- und Diabeteszentrum NRW, Universitätsklinik der Ruhr-Universität Bochum, Bad Oeynhausen, Germany.
Insights
This study demonstrates the first simultaneous treatment of hypertrophic obstructive cardiomyopathy (HOCM) and coronary artery disease (CAD) using percutaneous transluminal septal myocardial ablation (PTSMA) and percutaneous transluminal coronary angioplasty (PTCA). The combined procedure successfully reduced the LVOT gradient and treated LAD stenosis without complications.
Area of Science:
- Interventional Cardiology
- Cardiovascular Medicine
- Medical Technology
Background:
- Percutaneous transluminal coronary angioplasty (PTCA) is a standard treatment for coronary artery disease (CAD).
- Percutaneous transluminal septal myocardial ablation (PTSMA) is an emerging therapy for symptomatic hypertrophic obstructive cardiomyopathy (HOCM).
- Simultaneous treatment of co-existing HOCM and CAD presents unique clinical challenges.
Observation:
- A 62-year-old patient with significant HOCM and a 75% stenosis in the left anterior descending (LAD) artery was treated.
- A novel double-wire technique enabled simultaneous PTSMA of the septal branch and PTCA of the LAD stenosis.
- Fractional alcohol injection achieved septal ablation, reducing the left ventricular outflow tract (LVOT) gradient from 80 to 9 mmHg.
Findings:
- The combined PTSMA and PTCA procedure was technically successful in the reported case.
- Significant reduction in LVOT gradient was observed post-PTSMA.
- LAD stenosis was successfully dilated and stented following septal ablation.
- No major complications such as trifascicular block or ventricular dysrhythmia occurred during hospitalization.
Implications:
- Combined PTSMA and PTCA offers a potential therapeutic alternative to combined surgical intervention for select patients with symptomatic HOCM and CAD.
- Careful consideration of potential complications is crucial when evaluating this combined approach.
- This case highlights the feasibility of a hybrid interventional strategy for complex cardiovascular conditions.
Abstract:
Percutaneous transluminal coronary angioplasty (PTCA) is an established therapy for coronary artery disease (CAD), whereas percutaneous transluminal septal myocardial ablation (PTSMA) is becoming increasingly significant in the therapy of symptomatic patients with hypertrophic obstructive cardiomyopathy (HOCM). We report the first ever simultaneous treatment, in a 62-yr-old patient, of significant HOCM and a 75% LAD stenosis from which the septal branch to be occluded stemmed. Using a double wire technique, first the septal branch was occluded through a fractional injection of 4 ml absolute alcohol, thus ablating the hypertrophied septal myocardium with reduction of the left ventricular outflow tract (LVOT) gradient at rest from 80 to 9 mmHg. Following this, the LAD stenosis was dilated and stented. Complications, in particular a trifascicular block or ventricular dysrhythmia, did not occur during the hospital stay. To conclude, combined PTSMA and PTCA may be considered as a therapeutic alternative to a combined surgical intervention in individual cases of symptomatic HOCM and CAD, provided that the potential complications are taken into account.