Images in cardiovascular medicine. Covered stent septal ablation for hypertrophic obstructive cardiomyopathy: initial success but ultimate failure resulting from collateral formation.

Abstract

A 76-year-old woman had syncope and exertional dyspnea. A systolic murmur was noted. An echocardiogram showed hypertrophic obstructive cardiomyopathy, with septal thickness 18 mm and peak left ventricular outflow tract (LVOT) gradient 78 mm Hg (Figure 1A). Coronary arteriography demonstrated mild coronary atherosclerosis, with mild stenosis of the proximal left anterior descending (LAD) coronary artery involving the first septal branch creating an unfavorable angle of entry into this branch (Figure 2A). Attempts to catheterize the first septal branch with an angioplasty balloon catheter for intracoronary …