[SCD-FORUM] 80S RE: HCM in 49-year-old man. Dr. Rondon

[SCD Symposium]

Dear Dr. Rafael S Leon de la Torre:

Interesting case and I dare to give my viewpoint, because in our  
Hospital we have had a casuistics (> 40 cases) of HOCM with cases of  
significant gradient (up to 130 mmHg) that have remarkably improved  
with pacemaker implantation in the RV tip with short AV delay to  
prevent entry of its own rhythm, and if is possible, to inhibit its  
triggering with oral beta blockers of the Atenolol type (1 or 2  
intakes a day for convenience).

Nowadays, our echocardiography specialists do not allow us to implant  
pacemakers in these patients, since with septal ablation with  
absolute alcohol with echocardiographic sectorization with  
intracoronary Acuson, we have an excellent response of decrease and  
even disappearance of gradients.

As regards myomectomy, we do not have any experience, even when we  
know that it is the most appropriate management, when by using other  
methods we have had no results, but in our hospital, as far as I  
know, there are only two cases performed over the last 20 years …  
therefore we cannot speak of experience.

The complication in your case is the presence of double gradient,  
which delimits the presence of nonlocated septal hypertrophy towards  
the LVOT but midseptal plus the one from the outflow that keep the  
major basal intermediary gradient… I think that the characterization  
with Acuson may be of great help in locations that could be ablated  
and have a lower degree of gradient in this patient.

We are very near and we can share this case study with you in our  
University Hospital of Caracas, for which I'm at your disposal to  
help your patient.

Regards,

Dr Mauricio Rondón

--
Dr. Sergio Dubner
President of Scientific Committee

Dr. Edgardo Schapachnik
President of Steering Committee

>
> First of all, greetings. Congratulations for such an interesting  
> event.
> I have a case I would like to share. It is a young man (49 years  
> old) with hypertrophic cardiomyopathy diagnosed years ago.
> Now he is very symptomatic, with angina in rest and crises of  
> palpitations accompanied by dizziness, and we could not document  
> which type they are. In echocardiogram I have found besides septal  
> hypertrophy of 23 mm, double gradient, one in LVOT, peak of 68  
> mmHg, and another intraventricular, of 145 mmHg. He is being  
> treated with propranolol 40 mgs per 8 hours.
> My question is: would he benefit with a dual chamber pacemaker?  
> Would it be essential to implant ICD? Which of the options is more  
> appropriate (pacemaker, myectomy, or septal ablation)?
> Once again, congratulations,
> Dr. Rafael S. León de la Torre
> Cardiólogo-Ecocardiografista
> Centro de atención cardiovascular de Camaguey
> Cuba
>
> --
> Dr. Sergio Dubner
> President of Scientific Committee
>
> Dr. Edgardo Schapachnik
> President of Steering Committee
>
>
>
>
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