A 38-year-old man was admitted to an area hospital after fai | Figure 1
Cleveland Clinic
A 38-year-old man was admitted to an area hospital after fainting. He had been diagnosed with HOCM seven months before and was started on beta-blocker therapy.
As his symptoms worsened, the dosage was gradually raised, and he received an implantable cardioverter-defibrillator. Despite these measures, he suffered multiple episodes of dizziness and syncope. With the latest episode, he requested a transfer to Cleveland Clinic.
He was seen in the emergency department where he was alert and awake, severely dyspneic and suffering from chest discomfort.
Upon auscultation, a loud murmur was noted, indicating severe mitral valve insufficiency. Echocardiography confirmed severe HOCM with systolic anterior motion of the mitral valve and an outflow tract gradient exceeding 100 mm Hg. In addition, there was significant mitral valve prolapse consistent with Barlow’s valve. Urgent surgery was recommended.
Surgeons performed a septal myectomy and repaired the patient’s mitral valve using a novel technique that repositions the leaflets for virtually perfect coaptation without cutting or suturing. The repairs were checked with intraoperative echocardiography and found to be successful.
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