An Unusual Presentation of Persistent Dyspnea Following Alcohol Septal
Ablation For Obstructive Hypertrophic Cardiomyopathy
Abstract
Residual or recurrent symptoms after septal reduction therapy are most
often related to inadequate relief of left ventricular outflow
gradients. We recently encountered a 71-year-old woman with hypertrophic
cardiomyopathy (HCM) and prior alcohol septal ablation who had a unique
constellation of findings causing her symptoms. She was found to have
four potential causes for her symptoms, residual midventricular
obstruction, apical distribution of hypertrophy reducing end-diastolic
volume, constrictive pericarditis, and marked arterial stiffness, as
reflected by aortic atherosclerosis. She underwent complete
pericardiectomy, transaortic septal myectomy, transapical myectomy, and
replacement of a heavily calcified ascending aorta.