Rescue alcohol septal ablation in sepsis with multiorgan failure

Indian Heart Journal
Parag W BarwadBalram Bhargava

Abstract

A 55 year old male patient with a diagnosis of hypertrophic cardiomyopathy was admitted with features of sepsis related to cholangitis. Initial management with intravenous (i.v.) fluids and antibiotics did not cause any change in his general condition mandating an emergency endoscopic retrograde cholangio-pancreatography (ERCP). After successful retrieval of CBD stone on ERCP, patient had massive upper gastrointestinal bleed leading to hypotension and shock. Addition of inotropes had led to further deterioration in his clinical status with a mean arterial BP falling to 44 mm of Hg. His echocardiography showed a resting left ventricular outflow tract (LVOT) gradient of 90 mm of Hg and thus was taken up for emergency alcohol septal ablation (ASA). Immediately after ASA, patient had significant decrease in LVOT obstruction and rise of systemic arterial pressures. After 10 days of antibiotic therapy patient was discharged with a residual LVOT obstruction of 28 mm of Hg.

Citations

Dec 21, 2012·Indian Heart Journal·Ajay Bahl

Related Concepts

Ethanol
Antibiotics
Idiopathic Hypertrophic Subaortic Stenosis
Endoscopic Retrograde Cholangiopancreatography
Cholangitis
2D Echocardiography
Heart Septum
Hematochezia
Multiple Organ Failure
Ventricular Outflow Obstruction, Right

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