Successful alcohol septal ablation for late recurrence of left ventricular outflow tract obstruction after surgical myectomy in hypertrophic obstructive cardiomyopathy

An 18-year-old male patient, known with familial hypertrophic obstructive cardiomyopathy underwent a septal myectomy 10 years ago for significant left ventricular outflow tract (LVOT) obstruction. During follow-up a progressive increase in LVOT gradient was noted in association with severe mitral valve regurgitation. The patient underwent percutaneous alcohol septal ablation to induce regression of left ventricular hypertrophy. Coronary angiography, with intracoronary contrast and guided by echocardiographic imaging, was applied for localisation of the appropriate septal branch. The vessel was subsequently injected with 1.5 cc ethanol. No procedure-related complications were reported. The LVOT gradient decreased from 90 mmHg to 48 and 45 mmHg at rest 6 weeks and 6 months, respectively, after the procedure. Mitral valve regurgitation was significantly reduced. This case nicely illustrates the feasibility of percutaneous alcohol :septal ablation for recurrent LVOT obstruction 10 years after myectomy.