Alcohol Septal Ablation for Hypertrophic Obstructive Cardiomyopathy, the First Cases Series in Thailand
Noppadol Chamnarnphol MD*, Treechada Wisaratapong MD*
Affiliation : * Division of Cardiology, Department of Internal Medicine, Faculty of Medicine, Prince of Songkla University, Songkhla
Background : Alcohol septal ablation (ASA) is an emerging percutaneous technique to treat patients with
hypertrophic obstructive cardiomyopathy (HOCM) and refractory to medical therapy. ASA in Thailand has
never been reported.
Material and Method: The authors reviewed clinical and hemodynamic data of four patients with HOCM
before and after ASA performed between November 2007 and May 2008 in Songklanagarind Hospital.
Results : ASA without myocardial contrast echocardiography was done successfully in all four patients with
HOCM and refractory to medical therapy. The authors used the anatomical characteristics of vessel and
pressure-guided technique to identify the optimal septal perforator artery. The averages of left ventricular
outflow tract (LVOT) peak/mean pressure gradients (PPG/MPG) were 105/56 before and 32/18 mmHg imme-
diately after ASA, consecutively. There were further falls in LVOT PPG and MPG to averages of 14 and 8.5
mmHg respectively at 6-12 week follow-up. The mean absolute alcohol volume was 2.5 + 0.41 ml. Transient
complete atrioventricular block occurred in one patient. All patients reported substantial symptomatic
improvement.
Conclusion : The authors reported the first cases series of HOCM patients who underwent ASA in Thailand.
ASA without myocardial contrast echocardiography in carefully selected patient is feasible, effective, and
safe.
Keywords : Hypertrophic obstructive cardiomyopathy, Alcohol septal ablation
