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[Hypertrophic cardiomyopathy treated by interventional technique of septal reduction]
J A Marin-Neto1, M O Lima Filho, A Schmidt
1Hospital das Cínicas da Faculdade de Medicina de Ribeirão Preto--USP.
Insights
Percutaneous alcohol septal ablation effectively treated obstructive hypertrophic cardiomyopathy in a patient unsuitable for traditional interventions. This minimally invasive procedure relieved severe dyspnea and eliminated the dangerous left ventricular outflow tract obstruction.
Area of Science:
- Cardiology
- Interventional Cardiology
Background:
- Obstructive hypertrophic cardiomyopathy (oHCM) presents significant challenges, especially in patients with contraindications to standard treatments like pacemakers or surgery.
- Medical management often fails to adequately control symptoms in advanced cases.
Observation:
- A 75-year-old woman with severe, refractory dyspnea due to oHCM was considered a high-risk candidate for conventional therapies.
- A novel percutaneous approach was chosen, involving selective alcohol injection into a septal branch of the left anterior descending artery.
Findings:
- The procedure induced a controlled septal infarction, evidenced by ECG changes and enzyme elevation.
- The left ventricular outflow tract pressure gradient decreased from 66mmHg to zero immediately post-intervention.
- The patient experienced significant symptomatic improvement and sustained gradient reduction at two-month follow-up.
Implications:
- Percutaneous alcohol septal ablation offers a viable, less invasive therapeutic option for select oHCM patients.
- This technique can effectively reduce left ventricular outflow tract obstruction and improve quality of life.
- Further research into this interventional strategy for refractory oHCM is warranted.
Abstract:
A 75-year old woman with obstructive hypertrophic cardiomyopathy and class IV dyspnea refractory to medical management had relative contraindications for both pacemaker implantation and surgical approach. Percutaneous intervention was devised to perform the selective injection of absolute alcohol in the first septal branch of the left anterior descending coronary artery. This led to a limited septal infarction documented by ST elevation, enzymatic elevation and the appearance of complete right bundle branch block on the electrocardiogram. A baseline left ventricular outflow tract pressure gradient of 66mmHg was immediately abolished and no unexpected complications supervened. Currently, two months after the procedure, marked symptomatic relief is present and associated with the absence of obstructive outflow gradient, as documented by echocardiography.