Intracavitary pressure wire and intravascular ultrasound for the evaluation of combined symmetric hypertrophic cardiomyopathy and aortic stenosis in a patient with dyspnea and syncope: treatment with ethanol septal ablation.
Among the aging population, hypertrophic cardiomyopathy and aortic stenosis often coexist. Distinguishing the contributions of these two pathologies to the patient's symptoms of congestive heart failure, chest pain and syncope is often challenging. Furthermore, the appropriate treatment is highly dependent on a clear determination of pathophysiology. Here, we present a novel application of quantitative pressure-wire measurements and qualitative intravascular ultrasound assessment of the left ventricular outflow tract and aortic valve in determining the contributions of aortic stenosis and symmetric hypertrophic cardiomyopathy to the overall left ventricular-aortic gradient. After establishing that the majority of outflow obstruction was dynamic and related to the hypertrophic cardiomyopathy, the patient underwent successful ethanol septal ablation.
Wykrzykowska
Joanna J
JJ
Cardiovascular Division, Beth Israel Deaconess Medical Center, One Deaconess Road, Baker 4, Boston, MA 02215, USA.
Piazza
Gregory
G
Laham
Roger J
RJ
D000369:Aged, 80 and over; D001021:Aortic Valve / Q000000981:diagnostic imaging; D001024:Aortic Valve Stenosis / Q000150:complications / Q000000981:diagnostic imaging* / Q000628:therapy; D002312:Cardiomyopathy, Hypertrophic / Q000150:complications / Q000000981:diagnostic imaging* / Q000628:therapy; D017115:Catheter Ablation; D004417:Dyspnea / Q000000981:diagnostic imaging* / Q000209:etiology / Q000628:therapy; D000431:Ethanol / Q000627:therapeutic use; D006352:Heart Ventricles / Q000000981:diagnostic imaging; D006801:Humans; D008297:Male; D011312:Pressure; D013575:Syncope / Q000000981:diagnostic imaging* / Q000209:etiology / Q000628:therapy; D014463:Ultrasonography / Q000379:methods*
D000431:Ethanol