Venous septal alcohol ablation achieved marked symptomatic improvement and persistent left ventricular outflow tract gradient reduction at 6 months in 2 men with obstructive HCM.
Case Report (n=2)
Does venous septal alcohol ablation improve symptoms and reduce left ventricular outflow tract gradient in symptomatic men with obstructive hypertrophic cardiomyopathy and inadequate arterial septal ablation?
Venous septal alcohol ablation may serve as a feasible and effective salvage strategy for gradient reduction in obstructive HCM patients when conventional arterial access is inadequate.
Septal alcohol ablation (SAA) is an established septal reduction therapy for symptomatic obstructive hypertrophic cardiomyopathy (HCM); however, its efficacy depends on favorable septal arterial anatomy. In a subset of patients, arterial access may be limited by unfavorable anatomy or prior septal artery occlusion, rendering conventional SAA ineffective. We report the first case series describing venous SAA as an alternative and salvage strategy. Two symptomatic men with obstructive HCM underwent venous septal ethanol delivery after inadequate arterial septal ablation. In the first case, limited gradient reduction after arterial SAA prompted adjunctive venous ethanol infusion via the coronary sinus, resulting in sustained hemodynamic improvement. In the second case, prior arterial SAA had led to septal artery occlusion; repeat arterial intervention failed, and venous septal ethanol infusion using a controlled balloon-isolated technique achieved immediate and durable gradient reduction. At the 6-month follow-up, both patients demonstrated marked symptomatic improvement and persistent left ventricular outflow tract gradient reduction without conduction disturbances. Venous SAA may represent a feasible salvage strategy in carefully selected patients with obstructive HCM.
Uçar et al. (Mon,) conducted a case report in Obstructive hypertrophic cardiomyopathy (n=2). Venous septal alcohol ablation was evaluated on Symptomatic improvement and left ventricular outflow tract gradient reduction. Venous septal alcohol ablation achieved marked symptomatic improvement and persistent left ventricular outflow tract gradient reduction at 6 months in 2 men with obstructive HCM.