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DOI: 10.1055/s-2008-1027245
© Georg Thieme Verlag KG Stuttgart · New York
Resolution of Refractory Ascites after Transcoronary Septal Ablation for Hypertrophic Obstructive Cardiomyopathy in a Cirrhotic Patient
Ascites Resolution after TASHRückbildung des refraktären Aszites nach einer transkoronaren Ablation der Septumhypertrophie bei einer Patientin mit hypertroph-obstruktiver Kardiomyopathie und LeberzirrhosePublication History
manuscript received: 20.12.2007
manuscript accepted: 15.2.2008
Publication Date:
20 October 2008 (online)
![](https://www.thieme-connect.de/media/zfg/200810/lookinside/thumbnails/10.1055-s-2008-1027245-1.jpg)
Zusammenfassung
In diesem Bericht dokumentieren wir den ersten Fall einer kompletten Aszitesrückbildung nach transkoronaret Ablation der Septumhypertrophie (TASH) bei einer Zirrhose-Patientin mit hypertroph-obstruktiver Kardiomyopathie. Die 52-jährige Patientin mit dekompensierter äthyltoxischer Leberzirrhose wurde zur Anlage eines transjugulären intrahepatischen portosystemischen Shunts (TIPS) zugewiesen. Die kombinierte Diuretikatherapie mit Furosemid und Spironolacton musste aufgrund der ausgeprägten Hyponatriämie und des Anstiegs der Retentionsparameter beendet werden. Im Rahmen der TIPS-Evaluation wurde eine hypertroph-obstruktive Kardiomyopathie diagnostiziert. Wir führten eine transkoronare Ablation der Septumhypertrophie (TASH) durch, was eine komplette Rückbildung des Aszites ohne weitere Interventionen bewirkte.
Abstract
This report presents the first case of complete resolution of ascites after transcoronary ablation of septal hypertrophy (TASH) in a cirrhotic patient with concomitant hypertrophic cardiomyopathy (HOCM). A 52-years-old woman with decompensated alcoholic liver cirrhosis was referred to our department for placement of a transjugular intrahepatic portosystemic stent shunt (TIPS) to treat her refractory ascites. The initial treatment with furosemide and spironolactone had to be discontinued because of severe hyponatriemia and an increase of creatinine levels. During further evaluation, HOCM was diagnosed by echocardiography and cardiac catheterization. We performed TASH in order to relieve the dynamic obstruction of the ventricular outflow tract, and the ascites completely resolved without further interventions.
Schlüsselwörter
Aszites - Leberzirrhose - hypertroph-obstruktive Kardiomyopathie - transkoronare Ablation der Septumhypertrophie
Key words
ascites - liver cirrhosis - hypertrophic cardiomyopathy - transcoronary septal ablation
References
- 1 Ma Z, Lee S S. Cirrhotic cardiomyopathy: getting to the heart of the matter. Hepatology. 1996; 24 451-459
- 2 Yoerger D M, Weyman A E. Hypertrophic obstructive cardiomyopathy: mechanism of obstruction and response to therapy. Rev Cardiovasc Med. 2003; 4 199-215
- 3 Arroyo V, Gines P, Gerbes A L. et al . Definition and diagnostic criteria of refractory ascites and hepatorenal syndrome in cirrhosis. Hepatology. 1996; 23 164-176
- 4 Paramesh A S, Fairchild R B, Quinn T M. et al . Amelioration of hypertrophic cardiomyopathy using nonsurgical septal ablation in a cirrhotic patient prior to liver transplantation. Liver Transpl. 2005; 11 236-238
- 5 Blendis L, Wong F. The hyperdynamic circulation in cirrhosis: an overview. Pharmacol Ther. 2001; 89 221-231
- 6 Liu H, Lee S S. Cardiopulmonary dysfunction in cirrhosis. J Gastroentrol Hepatol. 1999; 14 600-608
- 7 Arroyo V, Colmenero J. Ascites and hepatorenal syndrome in cirrhosis: pathophysiological basis of therapy and current management. J Hepatol. 2003; 38 69-89
- 8 Mörner S, Lindqvist P, Waldenström A. et al . Right ventricular dysfunction in hypertrophic cardiomyopathy as evidenced by the myocardial performance index. Int J Cardiol. 2008; 124 57-63
- 9 Sigwart U. Non-surgical myocardial reduction for hypertrophic obstructive cardiomyopathy. Lancet. 1995; 346 211-214
- 10 Alam M, Dokainish H, Lakkis N. Alcohol septal ablation for hypertrophic obstructive cardiomyopathy: a systematic review of published studies. J Inverv Cardiol. 2006; 19 319-327
Prof. Dr. Frank Lammert
Department Medicine II, Saarland University Hospital, Saarland University
Kirrberger Straße
66421 Homburg
Germany
Phone: ++ 49/2 28/28 7/11 21 5
Fax: ++ 49/2 28/28 7/14 69 8
Email: frank.lammert@uks.eu