Key result
Micro-coil embolization reduces LVOT gradient ~89% at 6 months in single-coronary oHCM.
Why the study?
Coronary artery congenital anomalies can coexist with symptomatic obstructive HCM and add complexity to transcatheter septal ablation.
Does micro-coil embolization reduce LVOT gradient and improve symptoms in a patient with obstructive HCM and anomalous coronary anatomy?
Case Report (n=1)
Does micro-coil embolization reduce LVOT gradient and improve symptoms in a patient with obstructive HCM and anomalous coronary anatomy?
Micro-coil embolization is a feasible alternative to alcohol septal ablation for septal reduction in HOCM patients with complex anomalous coronary anatomy.
Answers are grounded in this paper and cite their sources.
May offer septal reduction option in anomalous coronary anatomy; hypothesis-generating and should not yet change practice.
Background: Transcatheter septal ablation is a minimally invasive therapeutic method for treating symptomatic obstructive hypertrophic cardiomyopathy (HCM). The procedure is an alternative to septal myectomy, and it can be achieved using different modalities. Coronary artery congenital anomalies can coexist with HCM and can add complexity to its treatment. Case summary: A 65-year-old female presented with angina, reduced exercise tolerance, palpitations, and dizziness. Echocardiography showed eccentric left ventricular hypertrophy with basal septal thickness of 20 mm and left ventricular outflow tract (LVOT) obstruction with maximum gradient of 209 mmHg. Cardiopulmonary exercise stress test showed a decreased oxygen uptake (VO2) of 13.7 ml/min/m2. Medical therapy titrated to maximum tolerated doses failed and septal reduction therapy was indicated. Prior to alcohol septal ablation (ASA), coronary angiography revealed a rare coronary artery anomaly, a single coronary artery originating from the right coronary sinus and the procedure was unsuccessful due to kinking of the over-the-wire (OTW) balloon, caused by the acute take-off angle of the septal branch. The second attempt was done using a microcatheter that was advanced to the septal branch over a hydrophilic coronary guidewire and embolization was done with two micro-coils 2mm × 2 cm. Procedural echocardiography revealed basal septal akinesia and reduced LVOT velocity from 7.24 m/s to 1.5 m/s. After six months, the patient reported a decreased frequency of chest pain and improved exercise tolerance. Echocardiography revealed the septal thickness of 15 mm, with an LVOT gradient of 24 mmHg. Follow-up CT coronary angiography confirmed a "single" coronary artery type R-III, with separate origins of LAD and Cx from the proximal RCA. Part of LAD went through the interventricular septum, forming a myocardial bridge, classified as a potentially "malignant" S subtype. Conclusion: Micro-coil embolization is a feasible alternative treatment to alcohol septal ablation in patients with obstructive HCM and anomalous origin and the course of coronary arteries.
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Mandić et al. (2025) conducted a case report in Hypertrophic obstructive cardiomyopathy with anomalous coronary artery (n=1). Micro-coil embolization was evaluated on Reduction in left ventricular outflow tract (LVOT) gradient and septal thickness. Micro-coil embolization successfully reduced the left ventricular outflow tract gradient from 209 mmHg to 24 mmHg at 6 months in a patient with obstructive hypertrophic cardiomyopathy and a single coronary artery.
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