Cor Vasa 2017, 59(5):e424-e429

Obstructive hypertrophic cardiomyopathy and aortic valve disease in elderly woman - a case for Cath lab or surgery?

Anna Chaloupka^a,c,*, Jan Krejčí^a,c, Ladislav Groch^a,c, Vladimír Horváth^a,b, Lenka Špinarová^a,c

^a I. interní kardioangiologická klinika, Fakultní nemocnice u sv. Anny v Brně, Brno, Česká republika

^b Centrum kardiovaskulární a transplantační chirurgie, Brno, Česká republika

^c Lékařská fakulta Masarykovy univerzity, Brno, Česká republika

Aim: Hypertrophic cardiomyopathy (HCM) is a relatively common genetic cardiac disease (1 : 500) that is largely heterogeneous in its presentation, prognosis and treatment strategies. As such it often represents a dilemma to primary care clinicians as well as cardiovascular specialists. With widening possibilities of the management of the disease it is important to bring relevant clinical cases, which can help to clarify often difficult questions, which may arise.
Methods/case presentation: We are reporting a case of 74-year-old woman with highly symptomatic obstructive hypertrophic cardiomyopathy (HOCM) in concomitance with mild and hemodynamically insignificant aortic valve steno-insufficiency with limiting symptoms refractory to maximal medical management, who was referred to our medical center for consideration of the optimal interventional treatment strategy.

Results: The patient underwent alcohol septal ablation with good immediate, but suboptimal long-term clinical effect. Within 1 year, the initially insignificant aortic stenosis progressed together with regeneration of the septal hypertrophy, thus the treatment strategy followed by combined surgical septal myectomy and aortic valve replacement and eventually even mitral valve replacement due to intraoperative complication. The 1-year follow-up showed optimal therapeutic effect. In Europe, alcohol septal ablation became a preferred initial interventional method for symptomatic patients with HOCM, especially for elderly patients with comorbidities. This case illustrates the fact that surgical septal myectomy complemented by the repair or replacement of valves, may be, for selected patients, method of choice even in our country.

Conclusion: We would like to emphasize the importance of the appropriate selection of patients for the intervention within this heterogeneous disease spectrum, especially patients with combined HOCM and valvular disease and underline the necessity of proper evaluation of the treatment strategy for each individual patient.

Keywords: Alcohol septal ablation; Aortic valve disease; Hypertrophic cardiomyopathy; Surgical septal myectomy

Received: June 16, 2016; Accepted: August 17, 2016; Published: October 1, 2017  Show citation