Obstructive Hypertrophic Cardiomyopathy and Aortic Stenosis With High Surgical Risk

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.

Keywords

• alcohol septal ablation
• aortic stenosis
• hypertrophic cardiomyopathy
• mavacamten
• TAVR
• transcatheter aortic valve replacement