title: Apical hypertrophic cardiomyopathy: preliminary attempt at palliation with use of subselective alcohol ablation.
abstract: We report a case of severe apical hypertrophic cardiomyopathy in order to discuss the nature of this unusual condition and the possibility of using selective alcohol ablation to effectively treat symptomatic hypertrophic cardiomyopathy that presents with apical aneurysm. A 73-year-old woman with severe, progressive dyspnea and intermittent chest pain was found to have localized left ventricular apical dyskinesia distal to an obstructive mid-distal muscular ring. The ring caused total systolic obliteration of the apical left ventricular cavity. Apical cavity pressure was extremely high, up to 330 mmHg-200 mmHg above that in the main left ventricular cavity. Because of the danger of apical rupture and clot formation, we attempted the experimental use of alcohol ablation for effective palliation. We present our pilot experience, offer a novel interpretation of the nature of this obscure entity, and possibly justify a new catheter treatment. In addition, we discuss the developmental, pathophysiologic, and clinical implications of this unusual form of hypertrophic cardiomyopathy. To our knowledge, ours is the first reported use of subselective, modified-protocol alcohol septal ablation to treat an obstructive mid-apical muscular ring in a patient with apical hypertrophic cardiomyopathy.
authors.affiliation: Department of Cardiology, Texas Heart Institute at St. Luke's Episcopal Hospital, Houston, Texas 77030, USA. pangelini@leachmancardiology.com
authors.forename: Paolo
authors.initials: P
authors.lastname: Angelini
authors.forename: Carlo
authors.initials: C
authors.lastname: Uribe
authors.forename: Jorge
authors.initials: J
authors.lastname: Monge
authors.forename: Jorge M
authors.initials: JM
authors.lastname: Escobar
authors.forename: Eduardo
authors.initials: E
authors.lastname: Hernandez-Vila
mesh_terms: D055011:Ablation Techniques; D000368:Aged; D006328:Cardiac Catheterization; D002312:Cardiomyopathy, Hypertrophic / Q000175:diagnosis / Q000503:physiopathology / Q000628:therapy*; D017023:Coronary Angiography; D015150:Echocardiography, Doppler; D004562:Electrocardiography; D000431:Ethanol / Q000627:therapeutic use*; D005260:Female; D006439:Hemodynamics; D006801:Humans; D008279:Magnetic Resonance Imaging; D010166:Palliative Care / Q000379:methods*; D016896:Treatment Outcome
chemical_list: D000431:Ethanol
keywords: Cardiomyopathy, hypertrophic/complications/epidemiology/physiopathology/therapy; ethanol/administration & dosage/therapeutic use; heart septum/pathology; hypertrophy, left ventricular/diagnosis; myocardial ischemia/complications; treatment outcome