Hypertrophic Obstructive Cardiomyopathy
2006; Lippincott Williams & Wilkins; Volume: 114; Issue: 17 Linguagem: Inglês
10.1161/circulationaha.106.631689
ISSN1524-4539
AutoresGeorgios Sianos, Michail I. Papafaklis, Eleni C. Vourvouri, Jurgen Ligthart, Timo Baks, Folkert J. ten Cate, Patrick W. Serruys,
Tópico(s)Cardiovascular Function and Risk Factors
ResumoHomeCirculationVol. 114, No. 17Hypertrophic Obstructive Cardiomyopathy Free AccessReview ArticlePDF/EPUBAboutView PDFView EPUBSections ToolsAdd to favoritesDownload citationsTrack citationsPermissions ShareShare onFacebookTwitterLinked InMendeleyReddit Jump toFree AccessReview ArticlePDF/EPUBHypertrophic Obstructive CardiomyopathySeptal Ablation With Overlapping Sirolimus-Eluting and Covered Stents After Failed Alcoholization and Concomitant Coronary Artery Disease Georgios Sianos, MD, PhD, Michail I. Papafaklis, MD, Eleni C. Vourvouri, MD, PhD, Jurgen T. Ligthart, BSc, Timo Baks, MD, Folkert J. Ten Cate, MD, PhD and Patrick W. Serruys, MD, PhD Georgios SianosGeorgios Sianos From Thoraxcenter, Department of Cardiology (G.S., M.I.P., E.C.V., J.T.L., T.B., F.J.T.C., P.W.S.) and Department of Radiology (E.C.V., T.B.), Erasmus Medical Center, Rotterdam, The Netherlands. , Michail I. PapafaklisMichail I. Papafaklis From Thoraxcenter, Department of Cardiology (G.S., M.I.P., E.C.V., J.T.L., T.B., F.J.T.C., P.W.S.) and Department of Radiology (E.C.V., T.B.), Erasmus Medical Center, Rotterdam, The Netherlands. , Eleni C. VourvouriEleni C. Vourvouri From Thoraxcenter, Department of Cardiology (G.S., M.I.P., E.C.V., J.T.L., T.B., F.J.T.C., P.W.S.) and Department of Radiology (E.C.V., T.B.), Erasmus Medical Center, Rotterdam, The Netherlands. , Jurgen T. LigthartJurgen T. Ligthart From Thoraxcenter, Department of Cardiology (G.S., M.I.P., E.C.V., J.T.L., T.B., F.J.T.C., P.W.S.) and Department of Radiology (E.C.V., T.B.), Erasmus Medical Center, Rotterdam, The Netherlands. , Timo BaksTimo Baks From Thoraxcenter, Department of Cardiology (G.S., M.I.P., E.C.V., J.T.L., T.B., F.J.T.C., P.W.S.) and Department of Radiology (E.C.V., T.B.), Erasmus Medical Center, Rotterdam, The Netherlands. , Folkert J. Ten CateFolkert J. Ten Cate From Thoraxcenter, Department of Cardiology (G.S., M.I.P., E.C.V., J.T.L., T.B., F.J.T.C., P.W.S.) and Department of Radiology (E.C.V., T.B.), Erasmus Medical Center, Rotterdam, The Netherlands. and Patrick W. SerruysPatrick W. Serruys From Thoraxcenter, Department of Cardiology (G.S., M.I.P., E.C.V., J.T.L., T.B., F.J.T.C., P.W.S.) and Department of Radiology (E.C.V., T.B.), Erasmus Medical Center, Rotterdam, The Netherlands. Originally published24 Oct 2006https://doi.org/10.1161/CIRCULATIONAHA.106.631689Circulation. 2006;114:e553–e555A 61-year-old man with exertional dyspnea was diagnosed with hypertrophic obstructive cardiomyopathy. The echocardiogram demonstrated an interventricular septum with a thickness of 18 mm, marked systolic anterior motion, and mitral regurgitation grade 3. The left ventricular outflow tract (LVOT) gradient was 100 mm Hg. The patient was treated with percutaneous transluminal septal myocardial alcohol ablation, resulting in a residual LVOT gradient of 20 mm Hg. Mild coronary artery disease of the proximal left anterior descending coronary artery (LAD) and the first diagonal branch (D1) (40% diameter stenosis by quantitative coronary angiography) was left untreated.The patient remained asymptomatic for 6 months and then again had development of exertional dyspnea. The echocardiogram revealed relapse of the LVOT gradient (80 mm Hg). Repeat percutaneous transluminal septal myocardial alcohol ablation was planned. The invasive LVOT gradient was 77 mm Hg. Coronary angiography demonstrated progression of the disease of both lesions in the LAD and D1 (70% by quantitative coronary angiography). Because of the concomitant coronary artery disease, the treatment plan was changed. The LAD and the D1 were treated with sirolimus-eluting stent implantation (Figure 1A). Instead of injecting ethanol, a polytetrafluoroethylene-covered stent was implanted within the borders of the sirolimus-eluting stent over the ostium of the septal artery (Figure 1B). The procedure resulted in occlusion of the septal branch and immediate reduction of the LVOT gradient to 12 mm Hg (Figure 1C). The creatine kinase level rose to 789 IU/L. At 12 months' follow-up, the patient remained asymptomatic. Repeat angiography revealed no restenosis (Figure 1D), and intravascular ultrasound showed complete absence of neointima formation (Figure 1F and 1G). Furthermore, no signs of septal collateralization through the right coronary artery were noted (Figure 1E). There was no rest gradient. Multislice computed tomography imaging demonstrated good stent patency (Figure 2), and magnetic resonance imaging with gadolinium demonstrated the region of the infarcted interventricular septum (Figure 3). Septal reperfusion through collaterals leading to treatment failure after occlusion with covered stents has been previously reported.1,2 In our case, this probably was prevented by myocardial fibrosis and destruction of the microcirculation after the initial alcoholization. Download figureDownload PowerPointFigure 1. Angiographic images demonstrating the placement of a 3.5 × 28-mm, sirolimus-eluting stent (SES) (white arrowheads) in the LAD over the septal branch (SB) (white arrow) (A); the placement of a 3.5 × 12-mm, polytetrafluoethylene-covered stent (black arrowheads) within the SES over the ostium of the septal branch (B); the postprocedural result with complete absence of opacification of the SB (white arrow) (C); and the 12-month follow-up result with no signs of restenosis and persistent SB occlusion (D). E, Follow-up angiography of the right coronary artery (insert) depicting the SES (white arrowheads), the polytetrafluoethylene-covered stent (black arrowheads), and the absence of collateral formation or SB opacification (white arrow) during the delayed phase of contrast dye injection. The patency of the stented LAD without neointima formation was also affirmed by intravascular ultrasound both in the SES-only region (F, single-strut layer) and in the region of overlapping stents (G, triple-strut layer).Download figureDownload PowerPointFigure 2. Sixty-four–slice computed tomography angiogram. A, Volume-rendered image demonstrating the stented LAD (black arrow) and D1 (white arrow). B, Multiplanar reconstructed image showing the sirolimus-eluting stent (white arrowheads) and the polytetrafluoethylene-covered stent (black arrowheads) in the LAD and the sirolimus-eluting stent in the D1 (white arrow). The lumen within the stents is clearly visible without signs of neointima formation.Download figureDownload PowerPointFigure 3. Magnetic resonance imaging (1.5 Tesla) depicting the infarcted area (black arrows pointing at bright region) of the septum in 4-chamber (A), left ventricular outflow tract (B), and short-axis (C) views using an inversion-recovery T1-weighted gradient echo sequence 15 minutes after administration of 0.2 mmol/kg gadolinium-pentetic acid. RA indicates right atrium; LA, left atrium; LV, left ventricle; RV, right ventricle; and Ao, aortic root.DisclosuresNone.FootnotesCorrespondence to Georgios Sianos, MD, PhD, FESC, Department of Interventional Cardiology, Thoraxcenter, Erasmus Medical Center, Dr Molewaterplein 40, 3015 GD, Rotterdam, The Netherlands. E-mail [email protected]References1 Fifer MA, Yoerger DM, Picard MH, Vlahakes GJ, Palacios IF. 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Cattaneo P, Baravelli M, Rossi A, Mariscalco G, Romano M, Imperiale D, Bregasi A and Anzà C (2009) Ejection Fraction/Velocity Ratio Identifies Prosthesis-Patient Mismatches in Patients With Aortic Bioprosthetic Valves and Left Ventricular Dysfunction, Journal of Ultrasound in Medicine, 10.7863/jum.2009.28.9.1167, 28:9, (1167-1174), Online publication date: 1-Sep-2009. Ramcharitar S, Meliga E, Kirschbaum S, ten Cate F, van Geuns R and Serruys P (2008) Acute hemodynamic changes in percutaneous transluminal septal coil embolization for hypertrophic obstructive cardiomyopathy, Nature Clinical Practice Cardiovascular Medicine, 10.1038/ncpcardio1355, 5:12, (806-810), Online publication date: 1-Dec-2008. October 24, 2006Vol 114, Issue 17 Advertisement Article InformationMetrics https://doi.org/10.1161/CIRCULATIONAHA.106.631689PMID: 17060391 Originally publishedOctober 24, 2006 PDF download Advertisement SubjectsCardiomyopathyComputerized Tomography (CT)Stent
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