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Acute hemodynamic changes in percutaneous transluminal septal coil embolization for hypertrophic obstructive cardiomyopathy

Nature Clinical Practice Cardiovascular Medicine volume 5, pages 806–810 (2008)Cite this article

Abstract

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.

Investigations 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.

Diagnosis Severe symptomatic HOCM.

Management Coil embolization of the first two septal vessels resulted in a limited septal infarct (creatine kinase-MB 36.6 µg/l; troponin T 0.43 µg/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.

Conclusion Septal coil embolization acutely and effectively reduced the LVOTG in a patient with drug-refractory HOCM.

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Figure 1: The patient's coronary angiograms.
Figure 2: Hemodynamic assessment of left ventricular outflow tract gradient.
Figure 3: Gadolinium-enhanced MRI scans.
Figure 4: Pressure–volume loops acquired before (black line) and after (red line) coil implantation.

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Authors and Affiliations

  1. S Kirschbaum is a Research Fellow in the Department of Cardiology and RJ van Geuns is a Senior Cardiologist at Erasmus Medical Center, S Ramcharitar is a Clinical Fellow, F ten Cate is Chief of the Echocardiographic Laboratory and PW Serruys is Head of Interventional Cardiology at the Thoraxcenter, Erasmus Medical Center, Rotterdam, The Netherlands,

    Steve Ramcharitar, Sharon W Kirschbaum, Folkert J ten Cate, Robert Jan van Geuns & Patrick W Serruys

  2. E Meliga is an Interventional Cardiologist at San Giovanni Battista Hospital, Turin, Italy.,

    Emanuele Meliga

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  1. Steve Ramcharitar
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  2. Emanuele Meliga
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  3. Sharon W Kirschbaum
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  4. Folkert J ten Cate
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  5. Robert Jan van Geuns
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Corresponding author

Correspondence to Patrick W Serruys.

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The authors declare no competing financial interests.

Supplementary information

Supplementary Movie

Systolic anterior motion and the left ventricular outflow tract gradient at baseline, together with the Doppler flow across the outflow tract. (PPT 4794 kb)

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Ramcharitar, S., Meliga, E., Kirschbaum, S. et al. Acute hemodynamic changes in percutaneous transluminal septal coil embolization for hypertrophic obstructive cardiomyopathy. Nat Rev Cardiol 5, 806–810 (2008). https://doi.org/10.1038/ncpcardio1355

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