Alcohol septal ablation gone wrong- case report of a complication of hypertrophic obstructive cardiomyopathy treatment
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Abstract
Alcohol Septal Ablation (ASA) is an interventional procedure that involves injecting ethanol into a targeted septal artery, inducing localized tissue necrosis, and subsequently reducing septal thickness. Our experience highlights this method as an effective therapeutic intervention for symptomatic HOCM patients, providing relief from symptoms and enhancing cardiac function, reducing Left Ventricular Outflow Tract (LVOT) gradient. However, potential complications such as arrhythmia, Left Anterior Descending (LAD) dissection, cardiac tamponade, and coronary artery spasm are rare but necessitate careful patient selection and vigilant post-procedural monitoring. It is a reasonable therapeutic option especially in older patients with favourable coronary anatomy in the absence of mitral valve disease and if it is performed by an experienced operator.
We present a case of a 68-year-old man with Hypertrophic Obstructive Cardiomyopathy (HOCM), elevated LVOT gradient, and symptoms despite optimal medical therapy. He underwent alcohol septal ablation which was complicated by alcohol leakage likely via collateral circulation into the distal left anterior descending artery and obliteration of the vessel.
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ESC Guidelines for the Management of Cardiomyopathies 2023.
Ventricular Septal Myectomy for Obstructive Hypertrofic Cardiomyopathy.The American Journal of Cardiology 2022. https:doi.org/10.1016/j.amjcard2022.06.007
Maekawa Y, Takamisawa I, Takano H, Takayama M. Percutaneous transluminal septal myocardial ablation: past, present, and future. J Cardiol. 2022 Sep;80(3):211-217. doi: 10.1016/j.jjcc.2021.11.023. Epub 2021 Dec 16. PMID: 34924238.
Rigopoulos AG, Seggewiss H. A Decade of Percutaneous Septal Ablation in Hypertrophic Cardiomyopathy. Circ J 2011;75[1]:28–37. Doi: 10.1253/circj.CJ-10-0962.
Fernandes VL, Nielsen C, Nagueh SF, Herrin AE, Slifka C, Franklin J, Spencer WH 3rd. Follow-up of alcohol septal ablation for symptomatic hypertrophic obstructive cardiomyopathy the Baylor and Medical University of South Carolina experience 1996 to 2007. JACC Cardiovasc Interv. 2008 Oct;1(5):561-70. doi: 10.1016/j.jcin.2008.07.005. PMID: 19463359.
Ziaee A, Lim M, Stewart R, Kern MJ. Coronary artery occlusion after transluminal alcohol septal ablation: Differentiating dissection, spasm, and alcohol-induced no-reflow. Catheter Cardiovasc Interv 2005;64[2]:204–8. Doi: 10.1002/ccd.20261.
Pérez AMJ, de la Valenzuela MG, Blanes GJR, Sánchez CM del C, Martínez HJA, Chavarri VM. Balloon Rupture and Alcohol Leakage into the Left Anterior Descending Coronary Artery During Percutaneous Septal Ablation for Hypertrophic Obstructive Cardiomyopathy. Rev Esp Cardiol Engl Ed 2005;58[7]:872–4. Doi: 10.1016/S1885-5857(06)60517-3.
Keskin ÖF, Iyisoy A. An unusual complication during alcohol septal ablation: severe left anterior descending artery vasospasm causing cardiac arrest: a case report and review of the literature. Eur Heart J Case Rep 2019; 3[3]: ytz129. Doi: 10.1093/ehjcr/ytz129.
El Masry H, Breall JA. Alcohol septal ablation for hypertrophic obstructive cardiomyopathy. Curr Cardiol Rev. 2008 Aug;4(3):193-7. doi: 10.2174/157340308785160561. PMID: 19936195; PMCID: PMC2780820.