SIMULTANEOUS PERCUTANEOUS TREATMENT IN HYPERTROPHIC OBSTRUCTIVE CARDIOMYOPATHY AND CORONARY-ARTERY DISEASE - A CASE-REPORT

Percutaneous transluminal coronary angioplasty (PTCA) is an establishe d therapy for coronary artery disease (CAD), whereas percutaneous tran sluminal septal myocardial ablation (PTSMA) is becoming increasingly s ignificant in the therapy of symptomatic patients with hypertrophic ob structive cardiomyopathy (HOCM), We report the first ever simultaneous treatment, in a 62-yr-old patient, of significant HOCM and a 75% LAD stenosis from which the septal branch to be occluded stemmed, Using a double wire technique, first the septal branch was occluded through a fractional injection of 4 mi absolute alcohol, thus ablating the hyper trophied septal myocardium with reduction of the left ventricular outf low tract (LVOT) gradient at rest from 80 to 9 mmHg. Following this, t he LAD stenosis was dilated and stented, Complications, in particular a trifascicular block or ventricular dysrhythmia, did not occur during the hospital stay. To conclude, combined PTSMA and PTCA may be consid ered as a therapeutic alternative to a combined surgical intervention in individual cases of symptomatic HOCM and CAD, provided that the pot ential complications are taken into account. (C) 1998 Wiley-Liss, Inc.