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Alcohol septal ablation versus surgical myectomy: a patient with obstructive HCM

Nature Clinical Practice Cardiovascular Medicine volume 4, pages 570–576 (2007)Cite this article

Abstract

Background A 42-year-old woman with a 20-year history of obstructive hypertrophic cardiomyopathy was referred for alcohol septal ablation following a worsening of symptoms, which had persisted despite medical treatment.

Investigations Physical examination, electrocardiography, rest–exercise Doppler and two-dimensional echocardiography, coronary angiography, intracoronary myocardial contrast echocardiography, and intraoperative transesophageal and epicardial echocardiography.

Diagnosis Symptomatic obstructive hypertrophic cardiomyopathy.

Management The patient was deemed unsuitable for alcohol septal ablation and underwent surgical myectomy guided by intraoperative echocardiography.

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Figure 1: General features of the patient's obstructive hypertrophic cardiomyopathy at the time of referral for alcohol septal ablation.
Figure 2: Intracoronary myocardial contrast echocardiography in the harmonic imaging mode demonstrated that the patient was unsuitable for alcohol septal ablation.
Figure 3: Deemed unsuitable for alcohol septal ablation, the patient instead underwent surgical myectomy guided by echocardiography.
Figure 4: The role of myocardial contrast echocardiography in choosing between alcohol septal ablation and surgical myectomy for the treatment of patients with obstructive hypertrophic cardiomyopathy refractory to pharmacological treatment.

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Acknowledgements

The authors would like to thank Michael John for the English language editing of the manuscript.

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Authors and Affiliations

  1. G La Canna is Director and E Capritti and A Grimaldi are Assistant Directors of the Echocardiography Unit of the Cardiac Surgery Department, and O Alfieri is Professor of Cardiac Surgery and Chief of the Cardiac Surgery Department, F Airoldi is Assistant Director and A Colombo is Director of the Catheterization Laboratory, at the Vita-Salute San Raffaele University, Milan, Italy.,

    Giovanni La Canna, Flavio Airoldi, Elvia Capritti, Antonio Grimaldi, Antonio Colombo & Ottavio Alfieri

Authors
  1. Giovanni La Canna
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  2. Flavio Airoldi
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  3. Elvia Capritti
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  4. Antonio Grimaldi
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  5. Antonio Colombo
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  6. Ottavio Alfieri
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Correspondence to Giovanni La Canna.

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The authors declare no competing financial interests.

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La Canna, G., Airoldi, F., Capritti, E. et al. Alcohol septal ablation versus surgical myectomy: a patient with obstructive HCM. Nat Rev Cardiol 4, 570–576 (2007). https://doi.org/10.1038/ncpcardio0988

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