Yuzawa-Tsukada Naoko, Tokuda Michifumi, Miyamoto Takashi, Yoshimura Michihiro
Division of Cardiology, Department of Internal Medicine, The Jikei University Katsushika Medical Center, 6-41-2 Aoto, Katsushika-ku, Tokyo 125-8506, Japan.
Division of Cardiology, Saitama Cardiovascular Respiratory Center, Kumagaya, Saitama, Japan.
Eur Heart J Case Rep. 2023 Jan 6;7(1):ytac493. doi: 10.1093/ehjcr/ytac493. eCollection 2023 Jan.
Abnormalities of the mitral subvalvular apparatus are not uncommon in hypertrophic obstructive cardiomyopathy (HOCM). Where invasive treatment is indicated in these patients to reduce left ventricular outflow tract (LVOT) obstruction, surgical myectomy with mitral valve repair is recommended.
In this report, we describe the case of a patient with HOCM and anomalous papillary muscle anatomy, successfully treated by percutaneous transluminal septal myocardial ablation (PTSMA).
PTSMA effectively reduced septal myocardial thickness and LVOT gradient, with only mild residual systolic anterior motion and mitral regurgitation despite anomalous papillary muscle anatomy. Upon careful anatomical evaluation, PTSMA may be a suitable therapeutic option for patients with LVOT obstruction and mitral valve abnormalities who are poor surgical candidates.
二尖瓣瓣下结构异常在肥厚型梗阻性心肌病（HOCM）中并不少见。对于这些需要进行有创治疗以减轻左心室流出道（LVOT）梗阻的患者，推荐行二尖瓣修复的外科室间隔心肌切除术。
在本报告中，我们描述了1例HOCM合并乳头肌解剖结构异常的患者，经皮腔内室间隔心肌消融术（PTSMA）治疗成功。
尽管存在乳头肌解剖结构异常，但PTSMA有效减轻了室间隔心肌厚度和LVOT梯度，仅伴有轻度残余收缩期前向运动和二尖瓣反流。经仔细的解剖学评估，PTSMA可能是LVOT梗阻和二尖瓣异常且手术风险高的患者的合适治疗选择。
