Alcohol Septal Ablation without Myocardial Contrast Echocardiography for Hypertrophic Obstructive Cardiomyopathy
Noppadol Chamnarnphol MD*, Treechada Wisaratapong MD*, Sirichai Cheewatanakornkul MD*
Affiliation : * Division of Cardiology, Department of Internal Medicine, Faculty of Medicine, Prince of Songkla University, Songkhla, Thailand
Objective : Review the efficacy and safety of using the anatomical characteristics of the first septal branch to select the target
vessel for alcohol septal ablation (ASA) in treating patients with medically refractory symptoms hypertrophic obstructive
cardiomyopathy (HOCM), ASA without guided myocardial contrast echocardiography (MCE).
Material and Method: Fifteen patients with HOCM and refractory to medical therapy were screened by echocardiography
and coronary angiography between November 2007 and January 2010 in Songklanagarind university hospital. The procedure
was abandoned in three patients due to vessel unsuitability. The clinical and hemodynamic data of 12 patients with HOCM
before and after ASA were reviewed. The authors used the anatomical characteristics of vessel to identify the suitable septal
perforator artery.
Results : ASA was done successfully in 12 patients. The averages of left ventricular outflow tract (LVOT) peak/mean pressure
gradients (PPG/MPG) were 92.4 + 22.5/48.8 + 12.8 before and 21.6 + 11/12.8 + 5 mmHg immediately after ASA. The mean
absolute alcohol volume was 2.5 + 0.64 ml. One patient had to have alcohol injection into two septal branches. Transient
complete atrioventricular block occurred in two patients. All patients reported substantial symptomatic improvement.
Conclusion : Most patients with medically refractory symptom HCOM have suitable first septal branches for ASA. ASA
without MCE in those with suitable first septal branches is effective and safe.
Keywords : Hypertrophic obstructive cardiomyopathy, Alcohol septal ablation, The first septal branch, Myocardial contrast echocardiography
