Alcohol septal ablation for severe hypertrophic obstructive cardiomyopathy during pregnancy: Rare presentation a successful procedure

Abstract

Hypertrophic Obstructive Cardiomyopathy (HOCM) during pregnancy is rare but poses significant maternal and fetal risks due to increased cardiac workload and dynamic left ventricular outflow tract (LVOT) obstruction. We report a 21-year-old primigravida at 28+6 weeks gestation who presented with progressive dyspnea and bilateral pedal edema. Echocardiography revealed HOCM with severe LVOT obstruction (150/20 mmHg) and mild mitral regurgitation. Following multidisciplinary evaluation, the patient underwent Alcohol Septal Ablation (ASA) under fetal protection shield and temporary pacing support. Post-procedure, LVOT gradient reduced to 45/15 mmHg with hemodynamic stability and satisfactory fetal wellbeing. The patient improved clinically and was discharged in stable condition. This case highlights the feasibility, safety, and innovation of performing ASA during pregnancy with collaborative multidisciplinary support, ensuring favorable maternal and fetal outcomes.