Acute hemodynamic changes in percutaneous transluminal septal coil embolization for hypertrophic obstructive cardiomyopathy.
BACKGROUND
A 48-year-old man with hypertrophic obstructive cardiomyopathy (HOCM) presented with palpitations, symptoms of medically refractory class II angina, and NYHA class II-III heart failure.


METHODS
Physical examination revealed a grade 3 systolic murmur that increased to grade 4 with exercise. Echocardiography showed marked septal thickening (17 mm), a left ventricular outflow tract gradient (LVOTG) of 95 mmHg, and a 3+ systolic anterior motion of the mitral valve apparatus. No other pathology was noted with cardiac MRI or with coronary angiography.


METHODS
Severe symptomatic HOCM.


RESULTS
Coil embolization of the first two septal vessels resulted in a limited septal infarct (creatine kinase-MB 36.6 microg/l; troponin T 0.43 microg/l) that corresponded to a mass of 8.1 g on gadolinium contrast cardiac MRI. The LVOTG decreased immediately from 78 mmHg to 35 mmHg. On pressure-volume loops, contractile isovolemic and systolic ejectional parameters decreased, while an improvement in diastolic left ventricular function was observed.


CONCLUSIONS
Septal coil embolization acutely and effectively reduced the LVOTG in a patient with drug-refractory HOCM.
Thoraxcenter, Erasmus Medical Center, Rotterdam, The Netherlands.
Steve
S
Ramcharitar
Emanuele
E
Meliga
Sharon W
SW
Kirschbaum
Folkert J
FJ
ten Cate
Robert Jan
RJ
van Geuns
Patrick W
PW
Serruys
D000787:Angina Pectoris / Q000209:etiology / Q000628:therapy; D002312:Cardiomyopathy, Hypertrophic / Q000150:complications / Q000473:pathology / Q000503:physiopathology / Q000628:therapy*; D017023:Coronary Angiography; D003937:Diagnosis, Differential; D004621:Embolization, Therapeutic / Q000295:instrumentation*; D004867:Equipment Design; D006333:Heart Failure / Q000209:etiology / Q000628:therapy; D006439:Hemodynamics; D006801:Humans; D008279:Magnetic Resonance Imaging; D008297:Male; D008875:Middle Aged; D012720:Severity of Illness Index; D016896:Treatment Outcome; D014694:Ventricular Outflow Obstruction / Q000209:etiology / Q000503:physiopathology / Q000628:therapy