[The therapeutic focus in severe hypertrophic obstructive cardiomyopathy with multivessel coronary disease].
The association of severe hypertrophic obstructive cardiomyopathy and coronary artery disease increases surgical morbimortality, even more in patients over 65 years. We describe a combined therapeutic approach to these diseases. A 68-year-old woman with a diagnosis of hypertrophic obstructive cardiomyopathy was in functional class IV for angina and dyspnea despite 360 mg of propranolol a day. An echocardiogram and a complete cardiac catheterization were performed under betablocker therapy, confirming a severe hypertrophic obstructive cardiomyopathy and revealing severe stenosis in the proximal left circumflex and the proximal right coronary arteries, and a moderate lesion in the mid-left anterior descendent. They were both treated with balloon PTCA, and a 3 x 15 mm stent was placed in the circumflex and a 3.5 x 20 mm stent in the right coronary, with an excellent angiographic result. A basal hemodynamic study was then performed and A-V sequential pacing was attempted, achieving a significant decrease in the left ventricle outflow tract gradient. A DDD-R pacemaker was implanted. Echocardiographic study was performed post-implantation, and follow-up was made six months later with a new coronary angiography, hemodynamic study and a Doppler echocardiogram. At the present time A-V sequential pacing as a therapeutic option for hypertrophic obstructive cardiomyopathy and coronary angioplasty and stenting for the treatment of coronary artery disease are sufficiently established and supported to be offered as a combined therapy to patients suffering from both diseases, specially those with a higher surgical risk.
Tascón Pérez
J C
JC
Servicio de Cardiología, Hospital Universitario 12 de Octubre, Madrid.
González-Trevilla
A A
AA
Gutiérrez
M A
MA
Dussac
J A
JA
Hernández Hernández
F
F
Sánchez Sánchez
V
V
Rodríguez García
J
J
D000368:Aged; D000787:Angina Pectoris / Q000175:diagnosis / Q000503:physiopathology / Q000628:therapy; D015906:Angioplasty, Balloon, Coronary; D002312:Cardiomyopathy, Hypertrophic / Q000175:diagnosis / Q000503:physiopathology / Q000628:therapy*; D003131:Combined Modality Therapy; D017023:Coronary Angiography; D003327:Coronary Disease / Q000175:diagnosis / Q000503:physiopathology / Q000628:therapy*; D015150:Echocardiography, Doppler; D005260:Female; D005500:Follow-Up Studies; D006439:Hemodynamics; D006801:Humans; D010138:Pacemaker, Artificial; D015607:Stents
Enfoque terapéutico en la miocardiopatía hipertrófica obstructiva severa con enfermedad coronaria multivaso.