title: Rescue alcohol septal ablation in sepsis with multiorgan failure.
abstract: A 55 year old male patient with a diagnosis of hypertrophic cardiomyopathy was admitted with features of sepsis related to cholangitis. Initial management with intravenous (i.v.) fluids and antibiotics did not cause any change in his general condition mandating an emergency endoscopic retrograde cholangio-pancreatography (ERCP). After successful retrieval of CBD stone on ERCP, patient had massive upper gastrointestinal bleed leading to hypotension and shock. Addition of inotropes had led to further deterioration in his clinical status with a mean arterial BP falling to 44 mm of Hg. His echocardiography showed a resting left ventricular outflow tract (LVOT) gradient of 90 mm of Hg and thus was taken up for emergency alcohol septal ablation (ASA). Immediately after ASA, patient had significant decrease in LVOT obstruction and rise of systemic arterial pressures. After 10 days of antibiotic therapy patient was discharged with a residual LVOT obstruction of 28 mm of Hg.
authors.affiliation: Department of Cardiology, All India Institute of Medical Sciences, New Delhi, India. paragaims@gmail.com
authors.forename: Parag W
authors.initials: PW
authors.lastname: Barwad
authors.forename: S
authors.initials: S
authors.lastname: Ramakrishnan
authors.forename: Sandeep
authors.initials: S
authors.lastname: Seth
authors.forename: Balram
authors.initials: B
authors.lastname: Bhargava
mesh_terms: D055011:Ablation Techniques / Q000379:methods*; D000900:Anti-Bacterial Agents / Q000627:therapeutic use; D002312:Cardiomyopathy, Hypertrophic / Q000188:drug therapy*; D002760:Cholangiopancreatography, Endoscopic Retrograde / Q000009:adverse effects*; D002761:Cholangitis / Q000150:complications* / Q000601:surgery; D004452:Echocardiography; D000431:Ethanol / Q000627:therapeutic use*; D006471:Gastrointestinal Hemorrhage / Q000209:etiology* / Q000628:therapy*; D006346:Heart Septum / Q000187:drug effects; D006801:Humans; D008297:Male; D008875:Middle Aged; D009102:Multiple Organ Failure / Q000209:etiology*; D018805:Sepsis / Q000209:etiology*; D014694:Ventricular Outflow Obstruction / Q000188:drug therapy* / Q000209:etiology*
chemical_list: D000900:Anti-Bacterial Agents; D000431:Ethanol