Alcohol Septal Ablation for Hypertrophic Obstructive Cardiomyopathy With Midventricular Obstruction and Papillary Muscle Abnormalities.
Study Goal
The researchers aimed to determine whether alcohol septal ablation (ASA) could effectively alleviate symptoms in a patient with hypertrophic obstructive cardiomyopathy (HOCM) complicated by anomalous papillary muscles and midventricular obstruction.
Results Summary
ASA successfully reduced the left ventricular outflow tract pressure gradient and improved symptoms (syncope, chest pain, and heart failure) in the patient, with sustained relief observed after 18 months. However, midventricular obstruction persisted immediately post-procedure, indicating partial efficacy.
Population
A 65-year-old woman with HOCM, midventricular obstruction, and anomalous papillary muscles.
Effective Dosage
Not specified (alcohol ablation via 6 septal branches).
Duration
Immediate post-procedure effects and 18-month follow-up.
Interactions
None mentioned.
| Intervention | Direction | Endpoint | Population | Dosage | Impact | Claim # |
|---|---|---|---|---|---|---|
alcohol septal ablation (ASA) | decrease | pressure gradient in the LV outflow tract | a 65-year-old woman with HOCM concomitant with midventricular obstruction and anomalous PMs | - | decreased considerably | #1 |
alcohol septal ablation (ASA) | no change | midventricular obstruction | a 65-year-old woman with HOCM concomitant with midventricular obstruction and anomalous PMs | - | persisted | #2 |
alcohol septal ablation (ASA) | decrease | syncope | a 65-year-old woman with HOCM concomitant with midventricular obstruction and anomalous PMs | - | no recurrent episodes | #3 |
alcohol septal ablation (ASA) | decrease | chest pain | a 65-year-old woman with HOCM concomitant with midventricular obstruction and anomalous PMs | - | no recurrent episodes | #4 |
alcohol septal ablation (ASA) | increase | heart failure-related symptoms | a 65-year-old woman with HOCM concomitant with midventricular obstruction and anomalous PMs | - | improved | #5 |
alcohol septal ablation (ASA) | decrease | LV outflow tract and midventricular obstructions | a 65-year-old woman with HOCM concomitant with midventricular obstruction and anomalous PMs | - | were relieved | #6 |
Although abnormal mitral valve complexes are frequently observed, alcohol septal ablation (ASA) for hypertrophic obstructive cardiomyopathy (HOCM) with an anomalous papillary muscle (PM) is challenging. We present the case of a 65-year-old woman with HOCM concomitant with midventricular obstruction and anomalous PMs. She was referred to our hospital for septal reduction therapy to alleviate recurrent syncope, chest pain, and heart failure symptoms. ASA was performed to ablate the left ventricular (LV) myocardium from the base to the middle via 6 septal branches. The pressure gradient in the LV outflow tract decreased considerably, and midventricular obstruction persisted immediately after ASA. There were no recurrent episodes of syncope or chest pain, and the heart failure-related symptoms improved. Eighteen months later, the LV outflow tract and midventricular obstructions were relieved. This case indicates that ASA is an alternative option to relieve symptoms, even if anomalous PMs and midventricular obstruction coexist in HOCM.