Successful alcohol septal ablation in a pregnant patient with symptomatic hypertrophic obstructive cardiomyopathy

Abstract

Hypertrophic cardiomyopathy is a clinically heterogeneous disease with common findings of ventricular hypertrophy, left ventricular outflow tract (LVOT) obstruction, mitral regurgitation, and diastolic dysfunction. Sometimes, the condition can lead to catastrophic cardiac events. Pregnancy can pose a larger challenge, due to medication restrictions associated with pregnancy. We report a case of a 43-year-old pregnant woman presenting with symptomatic hypertrophic obstructive cardiomyopathy (HOCM). As her pregnancy progressed, her HOCM worsened both symptomatically and by objective echocardiographic data. These changes continued despite optimized medical therapy. After an in-depth discussion with both the patient and family, we proceeded with alcohol septal ablation, which was successful in both reducing her LVOT gradient and her symptoms. Her pregnancy was overall uneventful, and both she and her child are doing well more than 4 years from the date of the procedure.<Learning objective: While medical therapy is the first-line approach to patients with hypertrophic cardiomyopathy (HCM), symptoms may still persist despite optimized medical therapy. If medical therapy fails in a pregnant patient with symptomatic HCM and a significant left ventricular outflow tract gradient, successful alcohol septal ablation can improve the gradient and relieve symptoms.>