Alternative 'block and delivery' approach for alcohol septal ablation in hypertrophic cardiomyopathy with ischemia: a case report.
Study Goal
The researchers aimed to evaluate the feasibility and effectiveness of a modified alcohol septal ablation technique for treating hypertrophic obstructive cardiomyopathy (HOCM) with concurrent coronary artery disease (CAD) in a resource-limited setting.
Results Summary
The modified alcohol septal ablation technique successfully reduced the left ventricular outflow tract (LVOT) gradient from 108 to 17 mmHg, with the patient showing complete symptom resolution and normal LVOT gradient at one-year follow-up. The study highlights the adaptability of the technique but is limited by its single-case design and resource constraints.
Population
A 40-year-old Asian female with HOCM, severe LVOTO, and significant coronary artery stenosis.
Effective Dosage
Not specified (alcohol used as an ablative agent, but exact dosage not detailed).
Duration
Staged interventions (PCI followed by alcohol septal ablation) with one-year follow-up.
Interactions
None mentioned.
| Intervention | Direction | Endpoint | Population | Dosage | Impact | Claim # |
|---|---|---|---|---|---|---|
modified 'block and delivery' alcohol septal ablation technique | decrease | LVOT gradient | patient with concurrent HCM and CAD | from 108 to 17 mmHg | effectively reduced | #1 |
staged interventions: a percutaneous coronary intervention (PCI) followed by alcohol septal ablation using a modified technique | increase | health status and symptoms | 40-year-old Asian female with HOCM and CAD | - | demonstrated good health, complete symptom resolution | #2 |
staged interventions: a percutaneous coronary intervention (PCI) followed by alcohol septal ablation using a modified technique | decrease | left ventricular outflow tract gradient | 40-year-old Asian female with HOCM and CAD | normal | demonstrated normal left ventricular outflow tract gradient | #3 |
BACKGROUND: Hypertrophic cardiomyopathy (HCM) is a prevalent hereditary cardiac disorder characterized by marked myocardial hypertrophy, which may lead to impaired diastolic function and relative myocardial ischemia. On rare occasions, HCM coexists with coronary artery disease (CAD), complicating therapeutic decisions due to heightened risks of heart failure and ischemic events. Treatment options for these patients commonly include surgical myomectomy or alcohol septal ablation, traditionally performed using an over-the-wire (OTW) balloon catheter. Here, we present a case in which a modified 'block and delivery' alcohol septal ablation technique was utilized, instead of the conventional OTW approach, in a patient with concurrent HCM and CAD within a resource-limited setting. CASE PRESENTATION: A 40-year-old Asian female presented with angina and acute heart failure in our clinic. Diagnostic evaluations revealed hypertrophic obstructive cardiomyopathy (HOCM) with severe left ventricular outflow tract obstruction (LVOTO) and significant coronary artery stenosis. Due to equipment constraints, the patient underwent staged interventions: a percutaneous coronary intervention (PCI) followed by alcohol septal ablation using a modified technique. This intervention effectively reduced the LVOT gradient from 108 to 17 mmHg. At the one-year follow-up, the patient demonstrated good health, complete symptom resolution, and a normal left ventricular outflow tract gradient. CONCLUSION: This case illustrates the feasibility of employing a modified alcohol septal ablation technique in resource-limited settings, highlighting the importance of adaptable and innovative approaches in managing complex cardiac conditions.