[Grafting and concomitant left ventricular myotomy-myectomy in a patient with coronary artery disease associated with hypertrophic obstructive cardiomyopathy].

A 44-year-old man complained of chest oppression and systolic murmur. Echocardiography showed subaortic stenosis with outflow gradient of 135 mmHg, interventricular septal thickness of 21 mm, left ventricular posterior wall thickness of 11 mm, and 2/4 mitral regurgitation. Selective coronary angiography demonstrated 75% stenosis in left anterior desending branch. Coronary artery revasculization comcomitant with left ventricular myotomy-myectomy was performed. He had a good recovery from operation, and was discharged in 19th days in NYHA class I. Echocardiography one month after operation showed mild outflow pressure gradient, light systolic anterior motion of mitral anterior leaflet, and 1/4 mitral regurgitation. Careful operative management, including myocardial protection, avoiding perporation of ventricular septum, and postoperative medical care are mandatory to this group of patients. The use of cathecholamine and Ca-blocker will be attentioned because of the increasing the left ventricular pressure gradient.