Work

Obstructive Hypertrophic Cardiomyopathy and Aortic Stenosis With High Surgical Risk

Year: 2025

Type: article

Abstract: BACKGROUND: Treatment and accurate assessment of aortic valve stenosis (AS) with concomitant obstructive hypertrophic cardiomyopathy (HCM) prove challenging. CASE SUMMARY: We present a case series of 6 patients with obstructive HCM and severe AS who underwent alcohol septal ablation (ASA) and follow-up reassessment of AS severity. AS severity was downgraded in 3 of 6 cases. One patient had residual obstruction necessitating mavacamten before transcatheter aortic valve replacement (TAVR). TAVR was performed in 2 of 6 cases. DISCUSSION: Doppler assessment of AS is technically challenging in HCM. A staged intervention with ASA and/or mavacamten before TAVR requires thoughtful consideration. The literature supports the use of ASA in a staged fashion before TAVR. Limited data are published on the use of mavacamten before TAVR. TAKE-HOME MESSAGES: ASA and mavacamten are effective means to relieve obstruction in patients with concomitant severe AS. The benefit is 2-fold: 1) this approach provides more accurate Doppler assessment of AS severity; and 2) it reduces the likelihood of complications during TAVR.

Source: JACC Case Reports

DOI: 10.1016/j.jaccas.2025.103779

Authors: Omar M. Abdelfattah, Robyn Bryde, Kutaiba Nazif, Matthew W. Martinez

Institutions: Morristown Medical Center, The University of Texas Medical Branch at Galveston, Atlantic Health System

Language: English

Topic: Cardiac Valve Diseases and Treatments

Subfield: Cardiology and Cardiovascular Medicine

Field: Medicine

Domain: Health Sciences

SDG: Good health and well-being

Open Access status: gold

Estimated APC paid: $850