Hello! Thank you for asking on HCM! Regarding your mother s diagnosis, first of all she would need to compensate her congestion symptomatology, An intensive therapy with i/v diuretics, possibly vessel dilators, and even inotropes would be necessary to relieve her signs and symptoms, to improve her hemodynamics; so each of the optional revascularisation strategies would be more feasible. Regarding your question, if coronary lesions are multiple and widely extended, especially when is it impossible to perform an angioplasty with stents implantation, then surgery is the next alternative. Facing your mother age and the resultant very low ejection fraction, surgery looks to impose serious risks for peri-procedural complication. So, the best option would be probably percutaneous coronary revascularisation. if this is not feasible, I would recommend medical therapy (with the above drugs) to improve her clinical status, and hoping for any of the above options is a near future second round. Hope to have been helpful! Wish a fast recovery for your mother! Greetings! Dr. Iliri