D-HCM Patient With Left Ventricular Assistance Device Who Was Uncontrolled in Medical Medical Treatment

The patient was 52-year-old man. During the initial hospitalization to another hospital due to heart failure in October 2008, LV wall motion exhibited globally severe hypokinesis with LV ejection fraction (LVEF) of 18.2% on echocardiography at admission. He was diagnosed as dilated phase of hypertrophic cardiomyopathy (D-HCM) by myocardial biopsy. Amiodarone had been started for non-sustained ventricular tachycardia (NSVT) since January 2011. In 2014 amiodarone-induced thyrotoxicosis type 2 occuered and heart failure had worsened. After we altered amiodarone to sotalol, ICD implantation was performed because of reappearance of NSVT. However, even after optimal medical treatment, NYHA functional class was 3 to 4 and levels of BNP were more than 1500 pg/mL. We decided to start intravenous dobutamine during hospitalization. Although dobutamine infusion improved dyspnea, repeat re-hospitalization was not avoided. Finally he had depended on dobutamine. In January 2016, he was transferred to the University of Tokyo for the purpose of implantation of left ventricular assist device (LVAD). LVAD implant surgery was successfully performed. Now he is waiting for a heart transplantation at home with NYHA class 2–3. We experienced the case of D-HCM who underwent LVAD implantation.