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Percutaneous transluminal septal coil embolisation as an alternative to alcohol septal ablation for hypertrophic obstructive cardiomyopathy
  1. A Lafont,
  2. E Durand,
  3. C Brasselet,
  4. E Mousseaux,
  5. A Hagege,
  6. M Desnos

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Alcohol septal ablation appears to be a successful strategy for severe obstructive cardiomyopathy, resulting in reductions in clinical symptoms and left ventricular outflow tract gradient (LVOTG). However, rates of mortality (1–4%) and permanent complete atrioventricular (AV) blockage (15–30%) associated with alcohol ablation in experienced centres are similar to surgical myectomy. We proposed to perform coil septal embolisation in order to avoid alcohol toxicity. We report the case of a 43 year old patient, who presented with severe heart failure symptoms (New York Heart Association (NYHA) functional class III) refractory to medical treatment. Echocardiography showed a maximal 18 mm end diastolic thickness of the high septum, and a basal 75 mm Hg LVOTG. A coil was advanced and dropped into the first and second septal branches (see panel). The clinical follow up was event-free without ventricular arrhythmia and AV blockage. At three months, the patient felt a dramatic improvement in his dyspnoea (NYHA class I), and the LVOTG was 25 mm Hg. At five months, the patient remained asymptomatic. Further studies are warranted to evaluate this new strategy.

Embedded Image

Coronary angiographic projection of the left anterior descending artery with first and second septal branches (arrows) before (A) and after (B) coil embolisation.