A CLINICAL CASE OF ALCOHOL SEPTAL ABLATION AND TRANSCATHETER AORTIC VALVE IMPLANTATION IN AN ELDERLY PATIENT WITH SEVERE AORTIC STENOSIS AND HYPERTROPHIC OBSTRUCTIVE CARDIOMYOPATHY

Abstract

The development and widespread use of minimally invasive treatment methods is the tendency of recent decades in cardiovascular surgery. In this clinical case, the experience of using a combination of alcohol septal ablation and transcatheter aortic valve implantation is described. The tactic of treating the patient in two stages made it possible to significantly reduce the pressure gradient on the left ventricular outflow tract by ablating the interventricular septum before performing TAVI and reduce the risk of acute subvalvular obstruction. Cases of alcohol septal ablation after aortic valve endoprosthesis are described as a lifesaving therapeutic tool when other treatment methods are ineffective. Our clinical case demonstrates the possibility of preventing the development of an acute emergency (cardiogenic shock, «suicidal left ventricle») by surgically reducing the pressure gradient using alcohol septal ablation as the first stage in a patient with obstructive HCM and severe aortic stenosis.