Four-dimensional Flow Cardiac MRI for Hemodynamic Assessment of Alcohol Septal Ablation for Hypertrophic Obstructive Cardiomyopathy with Multiple Obstructions.

Four-dimensional (4D) flow cardiac MRI can be used to assess hemodynamics in patients with hypertrophic obstructive cardiomyopathy (HOCM) undergoing alcohol septal ablation (ASA). However, to the best of the authors' knowledge, no study has reported on insufficient or successful ASA evaluated with 4D flow cardiac MRI in HOCM with multiple obstructions. This case report presents a 74-year-old female patient who was diagnosed with HOCM with left ventricular (LV) outflow tract obstruction and midventricular obstruction. Repeat ASA targeting the LV outflow tract the first time and the midventricle the second time was conducted. Four-dimensional flow cardiac MRI performed before ASA, after the first ASA, and after the second ASA showed serial changes in the flow pathway and acceleration at the midventricle. Supplemental material is available for this article. © RSNA, 2023.