Author + information
Patient initials or identifier number
Relevant clinical history and physical exam
A 58 years-old male suffered from exertional dyspnea and chest pain. Medical and imaging examination revealed no coronary artery disease or arrhythmia. Echocardiography showed asymmetrical septal hypertrophy and left ventricular outflow tract (LVOT) obstruction with peak pressure gradient of 97 mmHg, and he was diagnosed HOCM.
A 7Fr sheath was inserted through the right femoral artery, and a SPB3.5 guiding catheter was positioned at the origin of left main. After the advancement of 0.014 SION wire into septal branch, 2.0 mm over the wire balloon was inserted through the guide wire. Following balloon inflation and intracoronary myocardial contrast echocardiography, ethyl alcohol injected through the catheter lumen to cause proximal interventricular septum infarction and relief of outflow tract obstruction with improved patient symptoms. The imaging procedure of CT perfusion imaging was repeatedly performed before, one week and one month after PTSMA. That data were obtained at 50 seconds, 3 minutes, and 20 minutes at injection of 77 ml contrast material total. Radiation absorbed dose was 30 mGy, 26 mGy, 27 mGy, respectively in each phases.
The CT perfusion was performed before and after PTSMA. The myocardial 3D-fusion model with coronary artery trees were constructed. After PTSMA early-defect of enhancement was observed in territories of the first and the second septal branches, and the volume of early-defect lesion was calculated as 9 ml. Delayed-enhancement also observed at the same territories. The CT perfusion is a promising modality to evaluate the results of PTSMA as same as the MRI perfusion.