Structural Heart Disease > Cases

Hypertrophic Obstructive Cardiomyopathy Treated with Nonsurgical Septal Reduction Therapy
- Operator: Augusto D. Pichard, MD
Clinical presentation
A 63-year-old woman with known hypertrophic obstructive cardiomyopathy was admitted to our hospital for alcohol septal ablation therapy. She complained of severe chest pain despite medical treatment.
Baseline coronary angiogram
Electrocardiogram showed LVH strain pattern (Figure 1). Echocardiography confirmed hypertrophic cardiomyopathy with systolic anterior motion of the mitral valve and significant resting LVOT obstruction.
Cardiac Catheterization
Cardiac catheterization was performed via both femoral artery. Coronary angiography was normal. Pressure recordings were obtained using a 7Fr XB catheter with 3.5 cm curve and a 5Fr pigtail catheter (Figure 2). Left ventricular outflow gradient was 20 mm Hg at rest and 150 mmHg post-extrasystole.
First, a temporary pacemaker was placed at the apex of the right ventricle. The left coronary artery was engaged with a 7 Fr XB catheter 3.5 cm curve. Coronary angiography revealed a big septal artery, mainly supplying the hypertrophied myocardium of the basal septum (Figure 2). This was delineated by myocardial contrast echocardiography. The septal artery was selectively catheterized with a 2.0 X 15 mm Maverick balloon positioned at the distal portion of the artery and deployed by 10 atm (2.12 mm) (Figure 3). After intravenous administration of 2 mg morphine, 3ml absolute alcohol was slowly injected through the inflated balloon and into the vessel and was left for 5 minutes before the balloon was deflated. Coronary angioplasty showed no flow to the distal portion of the septal artery (Figure 4). After the procedure, intravenous pressure gradient was immediately decreased from 20 mm Hg to < 5 mmHg postextrasystole
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