Acute hemodynamic changes in percutaneous transluminal septal coil embolization for hypertrophic obstructive cardiomyopathy

Background: A 48-year-old man with hypertrophic obstructive cardiomyopathy (HOCM) presented with palpitations, symptoms of medically refractory class II angina, and NYHA class II-III heart failure. Investigations: Physical examination revealed a grade 3 systolic murmur that increased to grade 4 with exercise. Echocardiography showed marked septal thickening (17 mm), a left ventricular outflow tract gradient (LVOTG) of 95 mmHg, and a 3+ systolic anterior motion of the mitral valve apparatus. No other pathology was noted with cardiac MRI or with coronary angiography. Diagnosis: Severe symptomatic HOCM. Management: Coil embolization of the first two septal vessels resulted in a limited septal infarct (creatine kinase-MB 36.6 μg/l; troponin T 0.43 μg/l) that corresponded to a mass of 8.1 g on gadolinium contrast cardiac MRI. The LVOTG decreased immediately from 78 mmHg to 35 mmHg. On pressure-volume loops, contractile isovolemic and systolic ejectional parameters decreased, while an improvement in diastolic left ventricular function was observed. Conclusion: Septal coil embolization acutely and effectively reduced the LVOTG in a patient with drug-refractory HOCM.

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