[Obstructive cardiomyopathy and stenosing coronary atherosclerosis. Apropos of 5 cases].

Five cases of hypertrophic obstructive cardiomyopathy with coronary artery disease are reported; 2 males and 5 females, aged 27, 49, 64, 67, and 70 years respectively. Four patients had angina, the other being asymptomatic. The diagnosis of hypertrophic obstructive cardiomyopathy was based on the presence of at least 4 of the following 5 signs: an ejectional systolic murmur, an external carotid pulse tracing showing a second endsystolic peak, an echocardiogramme showing both systolic anterior motion of the mitral valve and asymmetrical septal hypertrophy biloculation and/or disaxation of the left ventricular cavity on selective angiography, and a spontaneous or provoked intraventricular pressure gradient of over 30 mm Hg. Coronary angiography showed one or more stenoses of over 70% on at least one of the three main coronary arteries in all patients. Two of the 5 patients underwent coronary artery bypass surgery without myomectomy; the remaining 3 patients were treated medically. All patients have been followed up for periods ranging from 8 months to 6 years (average: 4 years) with a favourable outcome in 4 of them who are currently asymptomatic; the other patient has moderate angina (non-operated, treated with propranolol). The frequency of the association of hypertrophic obstructive cardiomyopathy and coronary artery disease was initially underestimated, but in fact it does not appear to be uncommon. The association would seem to be fortuitous. The long-term prognosis is not known and the management is not codified. It would seem logical to propose simultaneous surgical correction of the two conditions by myomectomy and coronary bypass surgery when anatomically possible, when beta blocker therapy fails, despite a relatively high operative risk, according to the few published cases.