Z Gastroenterol 2008; 46(10): 1194-1197
DOI: 10.1055/s-2008-1027245
Case Report

© 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 LeberzirrhoseA. Höblinger1 , K. Tiemann2 , G. Nickenig3 , T. Sauerbruch1 , F. Lammert1, 2, 3
  • 1Department of Internal Medicine I, University Hospital Bonn
  • 2Department of Internal Medicine II, University Hospital Bonn
  • 3Department of Medicine II, Saarland University Hospital
Further Information

Publication History

manuscript received: 20.12.2007

manuscript accepted: 15.2.2008

Publication Date:
20 October 2008 (online)

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.

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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