Baggish A L, Smith R N, Palacios I, Vlahakes G J, Yoerger D M, Picard M H, Lowry P A, Jang I-K, Fifer M A
Department of Medicine, Massachusetts General Hospital, Boston, Massachusetts, USA.
Heart. 2006 Dec;92(12):1773-8. doi: 10.1136/hrt.2006.092007. Epub 2006 Jun 28.
The pathological effects and the mechanisms of action of intracoronary administration of ethanol for alcohol septal ablation (ASA) for the management of hypertrophic obstructive cardiomyopathy (HOCM) are unknown.
We examined surgical specimens and, in one case, autopsy specimens from four patients who underwent surgical septal myectomy 2 days to 14 months after unsuccessful ASA.
Pathological examination early after ASA showed coagulative necrosis of both the myocardium and the septal perforator arteries. Affected arteries were distended and occluded by necrotic intraluminal debris, without platelet-fibrin thrombi. Late after unsuccessful ASA, excised septal tissue was heterogeneous, containing a region of dense scar, and adjacent tissue containing viable myocytes and interspersed scar.
Intracoronary administration of ethanol in patients with HOCM causes acute myocardial infarction with vascular necrosis. The coagulative necrosis of the arteries, their distension by necrotic debris and the absence of platelet-fibrin thrombi distinguish ethanol-induced infarction from that caused by atherosclerotic coronary artery disease. The direct vascular toxicity of ethanol may be an important aspect of the mechanism of successful ASA.
冠状动脉内注射乙醇用于酒精性室间隔消融术（ASA）治疗肥厚性梗阻性心肌病（HOCM）的病理效应及作用机制尚不清楚。
我们检查了4例在ASA失败后2天至14个月接受外科室间隔心肌切除术患者的手术标本，其中1例还检查了尸检标本。
ASA术后早期的病理检查显示心肌和间隔穿支动脉均发生凝固性坏死。受累动脉扩张，管腔内被坏死碎片阻塞，无血小板纤维蛋白血栓形成。ASA失败后的晚期，切除的间隔组织不均一，包含一个致密瘢痕区域，以及含有存活心肌细胞和散在瘢痕的相邻组织。
HOCM患者冠状动脉内注射乙醇可导致急性心肌梗死伴血管坏死。动脉的凝固性坏死、坏死碎片使其扩张以及无血小板纤维蛋白血栓形成，将乙醇诱导的梗死与动脉粥样硬化性冠状动脉疾病所致梗死区分开来。乙醇的直接血管毒性可能是成功实施ASA机制的一个重要方面。
