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 mu g/l; troponin T 0.43 mu g/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. keywords coil embolization, hypertrophic obstructive cardiomyopathy,