Iqbal S M Mamun, Mondal Neuton, Khan Mafuza Tabassum, Hamim Ashir Faishal, Majumder Nurullah Mujahid, Barshan Anindita Das, Hasan Mohammad Jahid
M H Samorita Hospital and Medical College, Dhaka, Bangladesh.
Pi Research and Development Centre, Dhaka, Bangladesh.
Egypt Heart J. 2025 Apr 28;77(1):41. doi: 10.1186/s43044-025-00636-0.
Hypertrophic cardiomyopathy (HCM) is a prevalent hereditary cardiac disorder characterized by marked myocardial hypertrophy, which may lead to impaired diastolic function and relative myocardial ischemia. On rare occasions, HCM coexists with coronary artery disease (CAD), complicating therapeutic decisions due to heightened risks of heart failure and ischemic events. Treatment options for these patients commonly include surgical myomectomy or alcohol septal ablation, traditionally performed using an over-the-wire (OTW) balloon catheter. Here, we present a case in which a modified 'block and delivery' alcohol septal ablation technique was utilized, instead of the conventional OTW approach, in a patient with concurrent HCM and CAD within a resource-limited setting.
A 40-year-old Asian female presented with angina and acute heart failure in our clinic. Diagnostic evaluations revealed hypertrophic obstructive cardiomyopathy (HOCM) with severe left ventricular outflow tract obstruction (LVOTO) and significant coronary artery stenosis. Due to equipment constraints, the patient underwent staged interventions: a percutaneous coronary intervention (PCI) followed by alcohol septal ablation using a modified technique. This intervention effectively reduced the LVOT gradient from 108 to 17 mmHg. At the one-year follow-up, the patient demonstrated good health, complete symptom resolution, and a normal left ventricular outflow tract gradient.
This case illustrates the feasibility of employing a modified alcohol septal ablation technique in resource-limited settings, highlighting the importance of adaptable and innovative approaches in managing complex cardiac conditions.
肥厚型心肌病（HCM）是一种常见的遗传性心脏疾病，其特征为明显的心肌肥厚，这可能导致舒张功能受损和相对性心肌缺血。在极少数情况下，HCM与冠状动脉疾病（CAD）共存，由于心力衰竭和缺血事件风险增加，使治疗决策变得复杂。这些患者的治疗选择通常包括手术心肌切除术或酒精室间隔消融术，传统上使用导丝（OTW）球囊导管进行。在此，我们介绍一例在资源有限的情况下，对一名同时患有HCM和CAD的患者采用改良的“阻断与递送”酒精室间隔消融技术而非传统OTW方法的病例。
一名40岁的亚洲女性因心绞痛和急性心力衰竭前来我院就诊。诊断评估显示为肥厚型梗阻性心肌病（HOCM），伴有严重的左心室流出道梗阻（LVOTO）和明显的冠状动脉狭窄。由于设备限制，患者接受了分期干预：先进行经皮冠状动脉介入治疗（PCI），然后采用改良技术进行酒精室间隔消融。该干预有效地将LVOT梯度从108 mmHg降至17 mmHg。在一年的随访中，患者健康状况良好，症状完全缓解，左心室流出道梯度正常。
本病例说明了在资源有限的情况下采用改良酒精室间隔消融技术的可行性，突出了在处理复杂心脏疾病时采用适应性和创新性方法的重要性。
