Alcohol septal ablation in drug-refractory hypertrophic obstructive cardiomyopathy patient with multiple comorbidities.

Septal reduction therapy is an effective treatment for hypertrophic obstructive cardiomyopathy (HOCM). Alcohol septal ablation (ASA) is indicated for HOCM patients who are ineligible for surgical myectomy, but several tips exist for the management of high-risk patients with ASA. Here, we present a case of successful ASA in a HOCM patient with multiple comorbidities, including severe obesity, drug-refractory bronchial asthma, poorly controlled diabetes, and steroid-induced immunosuppression. Pre-procedural strict glycemic control, pre-treatment with corticosteroids for bronchospasm prevention, minimal puncture sites for device insertion, and myocardial contrast echocardiography-guided procedure contributed to the achievement of successful ASA. With careful periprocedural management, ASA is a safe and effective treatment option for drug-refractory HOCM, even in high-risk patients with multiple comorbidities. Learning objective: Alcohol septal ablation can be a beneficial and safe treatment option for hypertrophic obstructive cardiomyopathy patients with multiple comorbidities, including severe obesity, drug-refractory bronchial asthma, poorly controlled diabetes, and steroid-induced immunosuppression. Detailed periprocedural management, including myocardial contrast echocardiography-guided procedure, is the key for achievement.