Cas du mois Janvier 2023 - Chirurgie cardiaque-


Obstructive cardiomyopathy: What therapeutic procedures ?

64-year-old female patient

Class II NYHA dyspnea

Electrocardiogram: Sokolow index = 42

chest x-ray: without abnormality

Coronarography: no coronary stenosis

Illustration : Fig1,2 ; movie 1 (attached)

A transthoracic ultrasound showed LV asymmetric hypertrophy, the septum was measuring 21 mm, an average LV-Ao gradient at 100 mm Hg, an accessory pillar emerging from the septum blocking left ventricular outflow and whose chordae  are inserted on the large mitral valve, no aortic insufficiency or pulmonary arterial hypertension.

What is your diagnosis ?

The MRI confirmed the diagnosis of obstructive cardiomyopathy (fig3), what can be your therapeutic attitude?

Six months after the optimal treatment, there was no improvement in clinical symptoms and echographic paramethers, what can be your therapeutic proposal?