Use of percutaneous transluminal septal myocardial ablation for relief of outflow tract obstruction in cardiac amyloidosis: a novel therapeutic target.
Cardiac amyloidosis typically presents with diastolic heart failure, but asymmetrical septal hypertrophy with outflow tract obstruction has been described. We illustrate the case of a 71-year-old woman with biopsy-proven cardiac amyloidosis and severe medical comorbidities with refractory severe heart failure who had asymmetric septal hypertrophy, systolic anterior motion (SAM) of the mitral valve, and a resting left ventricular outflow tract gradient of 86 mm Hg, increasing to 102 mm Hg on Valsalva maneuver. She underwent percutaneous transluminal septal myocardial ablation (PTSMA) with a dramatic resolution of her SAM and outflow tract obstruction, confirmed by intracavitary pressure wire measurements. PTSMA is technically feasible in this context, and correction of outflow tract obstruction may represent a new therapeutic target in cardiac amyloidosis.
Murphy
Ross T
RT
The Cleveland Clinic Foundation, Cleveland, Ohio 44195, USA.
Ratliff
Norman B
NB
Lever
Harry M
HM
Kapadia
Samir R
SR
D000368:Aged; D000686:Amyloidosis / Q000150:complications* / Q000473:pathology; D001706:Biopsy; D006328:Cardiac Catheterization; D017115:Catheter Ablation / Q000379:methods*; D004452:Echocardiography; D005260:Female; D005500:Follow-Up Studies; D006346:Heart Septum / Q000601:surgery*; D006801:Humans; D014694:Ventricular Outflow Obstruction / Q000000981:diagnostic imaging / Q000209:etiology / Q000601:surgery*