OBSTRUCTIVE HYPERTHROPHIC CARDIOMYOPATHY AND AORTIC VALVE DISEASE IN ELDERLY WOMAN – A CASE FOR CATHLAB OR SURGERY? CASE REPORT

Aim: Hypertrophic cardiomyopathy (HCM) is a relatively common genetic cardiac disease (1:500) that is largely heterogeneous in its presentation, prognosis and treatment strategies. As such it often represents a dilemma to primary care clinicians as well as cardiovascular specialists. With widening possibilities of the management of the disease it is important to bring relevant clinical cases which can help to clarify often difficult questions which may arise.

Methods / Case presentation: We are reporting a case of 74-year-old woman with highly symptomatic obstructive hypertrophic cardiomyopathy (HOCM) in concomitance with aortic valve steno-insufficiency with limiting symptoms refractory to maximal medical management, who was referred to our medical center for consideration of the optimal interventional treatment strategy.

Results: The patient underwent alcohol septal ablation with suboptimal long-term clinical effect, followed by combined surgical septal myectomy and aortic valve replacement and eventually even mitral valve replacement due to intraoperative complication. The one-year follow up showed optimal therapeutic effect. In Europe, alcohol septal ablation became a preferred initial interventional method for symptomatic patients with HOCM, especially for elderly patients with comorbidies. This case illustrates the fact that surgical septal myectomy complemented by the repair or replacement of valves may be for selected patients method of choice even in our country.

Conclusion: We would like to emphasize the importance of the appropriate selection of patients for the intervention within this heterogeneous disease spectrum, especially patients with combined HOCM and valvular disease and underline the necessity of proper evaluation of the treatment strategy for each individual patient.