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A 69-year-old man, known with hypertrophic obstructive cardiomyopathy (HOCM), was referred to our hospital because of progressive hypoxaemia and sepsis after admission for respiratory infection. Once at the emergency department, cardiopulmonary resuscitation, intubation and mechanical ventilation were necessary. Despite vasopressors and colloids the patient remained haemodynamically unstable. Because of the conviction that the distributive shock, caused by sepsis, was worsened by an associated obstructive shock related to the HOCM, an alcohol septal ablation (ASA) was attempted in these acute circumstances. Immediately after the ASA the gradient over the left ventricular outflow tract disappeared and the mean arterial pressure and oxygenation increased. Despite his cardiovascular recuperation the patient died a couple of days later. Nevertheless we achieved an improvement of the haemodynamic situation of this patient with HOCM by performing an urgent ASA.

An 18-year-old male patient, known with familial hypertrophic obstructive cardiomyopathy underwent a septal myectomy 10 years ago for significant left ventricular outflow tract (LVOT) obstruction. During follow-up a progressive increase in LVOT gradient was noted in association with severe mitral valve regurgitation. The patient underwent percutaneous alcohol septal ablation to induce regression of left ventricular hypertrophy. Coronary angiography, with intracoronary contrast and guided by echocardiographic imaging, was applied for localisation of the appropriate septal branch. The vessel was subsequently injected with 1.5 cc ethanol. No procedure-related complications were reported. The LVOT gradient decreased from 90 mmHg to 48 and 45 mmHg at rest 6 weeks and 6 months, respectively, after the procedure. Mitral valve regurgitation was significantly reduced. This case nicely illustrates the feasibility of percutaneous alcohol septal ablation for recurrent LVOT obstruction 10 years after myectomy.