Cor Vasa 2002, 43(5):244-248
Infected pacemaker extraction and alcoholic interventricular septal ablation in a female patient with obstructive hypertrophic cardiomyopathy
- Kardiologické oddělení, Nemocnice Na Homolce, Praha, Česká republika
The present case report describes a female patient implanted a dual-chamber pacemaker because of left ventricular (LV) outflow tract obstruction in the presence of hypertrophic cardiomyopathy (HCMP). Despite cardiac pacing, the patient was significantly symptomatic, with exertional dyspnoe of NYHA Class II-III, occasional palpitations and exertional-related chest pain.
Following pacemaker re-implantation because of battery energy running low, the patient developed bed sore showing signs of infection within the subcutaneous pocket accommodating the device. The patient was admitted to our department for transvenous extraction of both pacing leads. Echocardiography demonstrated a mid-interventricular septal thickness of 27 mm and a serially determined LV outflow tract resting pressure gradient of 55 mm Hg, which made us refer the patient to a catheter-based assessment with invasive LV pressure gradient determination. The peak resting pressure gradient was 90 mm Hg on average, rising to 140 mm Hg after a provocation test using Valsalva's maneuver.
For this reason, the patient had, on another occasion, catheter-based alcohol interventricular ablation (NSRT). The result was a reduction in interventricular septal thickness to 9 mm and a LV pressure to 10 mm Hg; this was associated with complete remission of the patient's complaints. The improvement has persisted for 10 months since NSRT.
Keywords: Hypertrophic obstructive cardiomyopathy; Transvenous lead extraction; Alcoholic interventricular septal ablation
Published: May 1, 2002 Show citation