Multidetector Computerized Tomography Can Guide and Document Alcohol Septal Ablation in Hypertrophic Obstructive Cardiomyopathy

Cardiac imaging is of special value in the diagnosis and management of hypertrophic obstructive cardiomyopathy.1 Echocardiography2 and magnetic resonance imaging,3 in particular, have been used to diagnose the disorder, to elucidate its pathophysiology, and to guide and document the results of treatment.4A 41-year-old woman was evaluated for treatment of symptomatic hypertrophic obstructive cardiomyopathy. Because of a strong family history of hypertrophic and dilated cardiomyopathies, in some cases associated with sudden death, an automatic implantable cardioverter defibrillator was implanted. Despite treatment with metoprolol succinate, verapamil, and finally metoprolol plus diltiazem, she had New York Heart Association Class III dyspnea and fatigue; symptoms were worse after a meal. Echocardiography showed asymmetrical septal hypertrophy, systolic anterior motion of the mitral valve, and moderate tricuspid and mitral valves regurgitation (right ventriclular systolic pressure 50 to 60 mm Hg) (online-only Data Supplement Movies I to III).A multidetector computerized tomography (MDCT) study of the heart and coronary arteries was done to delineate 1) the degree and exact location of interventricular septal hypertrophy; 2) the presence and degree of systolic anterior motion of the mitral valve and mitral valve leaflet-septal contact; and 3) the anatomy of the coronary arterial supply to the hypertrophied interventricular septum.Electrocardiogram (ECG)-gated contrast enhanced MDCT scan was performed using a Siemens SOMATOM Definition AS 128-slice computerized tomography scanner (Siemens Medical Solutions, Forchheim, Germany). Imaging was performed from the ascending thoracic aorta to the level of the upper abdomen during a 6-second breath hold at end inspiration. We used a triphasic IV regimen: 60 mL of iodinated contrast (Isovue [Iopamidol] 370 mg …