Precision management of severe coronary artery calcification with concomitant left ventricular outflow tract obstruction: a case report

Background Severe coronary artery calcification (CAC) with hypertrophic cardiomyopathy (HCM) and left ventricular outflow tract obstruction (LVOTO) present complex diagnostic and therapeutic challenges. Case presentation A 72-year-old man with exertional chest pain and dyspnea exhibited multivessel CAC (total score; 1,696), asymmetric septal hypertrophy, and dynamic LVOTO. Percutaneous coronary intervention (PCI) was performed on the right coronary artery (RCA) and left circumflex artery (LCX) guided by quantitative flow ratio (QFR) and intravascular ultrasound (IVUS). Left anterior descending artery (LAD) lesions showed preserved function but microvascular dysfunction; no intervention was performed. Cardiac magnetic resonance imaging confirmed HCM with segmental fibrosis and LVOTO. Intervention and outcome Post-PCI, dual antiplatelet therapy was administered for 6 months, followed by aspirin monotherapy and oral mavacam (2.5 mg daily. After 4 months, the LVOT gradient decreased from 51 mmHg to 9–12 mmHg, with symptom resolution. Conclusion Multimodal management combining coronary physiology, intravascular imaging, and targeted pharmacotherapy effectively relieved myocardial ischemia and LVOTO, thereby providing a reference for complex cases.