Treatment of Severe Left Ventricular Outflow Tract Obstruction and Mitral Regurgitation With Alcohol Septal Ablation

Figure 1. M mode through MV demonstrating SAM of MV apparatus.

Figure 2. (A) Continuous-wave Doppler through the LVOT demonstrating a resting gradient of 150 mm Hg. (B) Continuous-wave Doppler through the LVOT demonstrating a gradient of 293 mm Hg following a PVC.

Figure 3. Continuous-wave Doppler through the MV demonstrating significantly higher peak gradient (256 mm Hg) and different waveform morphology than LVOT gradient.

Figure 4. (A) Invasive hemodynamics demonstrating a resting LV systolic pressure of 267 mm Hg and an aortic pressure of 130/53 mm Hg (137 mm Hg systolic gradient). (B) Invasive hemodynamics demonstrating classic “Brockenbrough-Braunwald-Morrow” sign following premature atrial contraction with an increased LV outflow gradient and a decrease in pulse pressure.

Figure 5. (A) Following ASA, continuous-wave Doppler through the LVOT now only demonstrates a resting gradient of 13 mm Hg. (B) Following ASA, continuous-wave Doppler through the LVOT now only demonstrates a 27 mm Hg gradient following a PVC.

Figure 6. Following ASA, invasive hemodynamics demonstrating a 10 mm Hg resting LV systolic gradient.

Figure 7. Three-month follow-up echocardiogram demonstrating LVOT gradient of 24 mm Hg.