P121 MITRAL VALVE STENOSIS ASSOCIATED WITH LEFT VENTRICULAR OUTFLOW TRACT OBSTRUCTION: A TERRIBLE COMBINATION WITH A DIFFICULT TREATMENT

Abstract Case n. 1 A 77 year–old woman with obstructive hypertrophic cardiomyopathy who had undergone alcohol septal ablation a reduction in dynamic left ventricular outflow tract (LVOT) gradient from 95 to 65 mmHg was hospitalized for pulmonary oedema. Echocardiography and cardiac catheterization confirmed the presence of mmHg, identified severe calcific mitral stenosis (3D planimetric area= 0,9 cm2). There postcapillary hypertension (pulmonary artery mean pressure 60 capillary wedge 26 mmHg). The patient underwent combined surgical intervention valve replacement (Epic 27 mm bioprosthesis) myectomy via mini–thoracotomic approach. After there were dehiscence infection thoracotomy right inguinal wounds, septic shock, hyporexia (with marked cachexia), emotional instability delirium. 21 days hospitalization ICU, transferred medical department died seven later. 2 82 associated hypertrophy LVOT obstruction admitted heart failure worsening renal function. Her comorbidities included diabetic neuropathy stage 4 chronic kidney disease. Cardiac excluded significant coronary disease; area cm2, 75 mmHg. Pulmonary 32 25 atrial 8 She deemed high–risk candidate. therefore treated initially peritoneal dialysis. However she demonstrated persisting congestion. An septostomy inserting 8–mm Atrial Flow Regulator subsequently performed, an immediate 18 In following months no more hospitalizations failure. Conclusion association between is elevated frequent episodes Surgical remains first therapeutical option. Nevertheless, older patients, dialysis may represent valuable solution, lower operative risk.