Severe HOCM in an Unexpected Pregnancy: A Case Report of Multidisciplinary Surgical Management

Document Type

Conference Proceeding - Restricted Access

Publication Date

5-8-2026

Abstract

Hypertrophic obstructive cardiomyopathy (HOCM) presents a complex challenge during pregnancy, as physiologic changes-including increased plasma volume, heart rate, and cardiac output-can exacerbate left ventricular outflow tract obstruction (LVOTO) and worsen arrhythmias. In a 2018 meta-analysis of 154 women who underwent cardiopulmonary bypass during pregnancy, maternal mortality was 11.2% and pregnancy loss occurred in 33.1%, highlighting the significant risks of invasive intervention. Despite this, guidance for managing severe HOCM in pregnancy remains limited due to a lack of prospective data stratified by LVOTO severity. This case describes the diagnostic course and multidisciplinary management of a 26-year-old pregnant patient with symptomatic HOCM and LVOTO who underwent septal myectomy, emphasizing strategies to optimize maternal cardiac function while supporting fetal viability.

Our patient is a 26-year-old G4P2012 with IBD, IDA, and HOCUM s/p septal myectomy. A holosystolic murmur was first noted in 2023, with the patient presenting to the ED one month later for exertional dyspnea and pleuritic chest pain, where bilateral PEs were diagnosed. She later delivered her second child via C/S one year later without complication. In 2025, preoperative echocardiography for a planned carpal tunnel release revealed asymmetric septal LV hypertrophy, grade III diastolic dysfunction, and dynamic LVOTO due to systolic anterior motion of the mitral valve. She was formally diagnosed with HOCM three months later. Shortly after, she was found to be 7-8 weeks pregnant and was referred to MFM and cardiomyopathy specialists. During pregnancy, she developed worsening orthopnea with elevated BNP, requiring admission. Repeat imaging demonstrated worsening LVOTO with a peak gradient of 135 mmHg, prompting further multidisciplinary Cardio-OB planning.

Management of severe symptomatic HOCM with dynamic LVOTO during pregnancy due to limited case data and unclear current guidelines. This case highlights the importance of individualized decision-making, as progressive hemodynamic and clinical deterioration may necessitate surgical intervention-such as septal myectomy or alcohol ablation-despite the considerable maternal and fetal risks associated with cardiopulmonary bypass. Early recognition, serial imaging, and multidisciplinary care are therefore essential to optimizing outcomes in high-risk HOCM pregnancies.

Comments

2026 Research Day Corewell Health West, Grand Rapids, MI, May 8, 2026. Abstract 2088

This document is currently not available here.

Share

COinS