Percutaneous Myocardial Ablation for Left Mid-Ventricular Obstructive Hypertrophic Cardiomyopathy

Abstract

Mid-ventricular obstructive hypertrophic cardiomyopathy (MVOHC) is a rare type of cardiomyopathy. The diagnosis is based on the hourglass appearance on the left ventriculogram and the presence of pressure gradient between apical and basal chamber of the ventriculum on the hemodynamic assessment. Atrio-ventricular sequential pacing and alcohol ablation have been proposed as less invasive alternatives to surgery for patients who fail to respond to pharmacologic therapy. The present case represents successful percutaneous treatment with alcohol ablation to patient with MVOHC and apical aneurysm. Alcohol ablation to distal segment of the left anterior descending artery resulted with relief of clinical symptoms and intra-ventricular pressure gradient.

Effectiveness of Alcohol Septal Ablation Versus Transaortic Extended Myectomy in Hypertrophic Cardiomyopathy with Midventricular Obstruction

“…Several case reports suggest that the target vessels for MVO are varying, which can be the first septal perforator artery, the fourth septal perforator artery, and the distal 1/3 of left anterior descending coronary artery. [17][18][19] In this study, the majority of patients had the first septal perforator artery ablated. This result was in line with that the first septal perforator artery is the most common dominant septal perforator artery, which supplies the widest septum area and most often supplies the obstructive muscle mass.…”

Left ventricular aneurysms in hypertrophic cardiomyopathy with midventricular obstruction: A systematic review of literature

“…Surgical aneurysmectomy or aneurysm ligation constitutes other alternatives to resolve complications of thromboembolism, ventricular arrhythmias, and cardiac dysfunction associated with LVA formation. Other surgical interventions include thrombectomy, myectomy, and alcohol septal ablation . Although surgical myectomy in HCM patients has been always thought to be reserved for patients with intractable symptoms despite medical therapy, Kunkala et al.…”

Mid-Ventricular Obstructive Hypertrophic Cardiomyopathy Associated with an Apical Aneurysm: Evaluation of Possible Causes of Aneurysm Formation

“…Generally, beta blockers are the first choice of treatment for patients with subaortic obstructive hypertrophic cardiomyopathy,12 but the optimal treatment for MVOHCM has not yet been established. Dual-chamber pacing13,14 and percutaneous myocardial ablation6,15 have been proposed as non-surgical treatments, but their long-term prognosis and procedural safety await further observation with a large patient population.…”