Alcohol septal ablation without myocardial contrast echocardiography for hypertrophic obstructive cardiomyopathy.

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.