Septal Embolization Using Ethylene Vinyl Alcohol Copolymer in Hypertrophic Obstructive Cardiomyopathy

Figures

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  Figure 1. Electrocardiographic Findings Before and After Septal Embolization With Onyx

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  Figure 2. Percutaneous Septal Reduction Therapy Using Onyx (A) Selective contrast injection into the left coronary artery. (B) Temporary occlusion of the LAD proximal to the origin of the first septal perforator. (C) Temporary occlusion of the LAD distal to the origin of the first septal perforator. (D) Positioning of the microcatheter in the midsegment of the first septal perforator branch. (E) Selective contrast injection into the first septal perforator to assess for retrograde reflux into the LAD before embolization. (F) Embolization of the first septal perforator using the liquid embolic agent Onyx. (G) LVOT gradient and flow velocity before septal embolization. (H) LVOT gradient and flow velocity after septal embolization with Onyx. LAD = left anterior descending artery; LVOT = left ventricular outflow tract.

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  Figure 3. Evolution on Cardiac Magnetic Resonance Before and After Septal Reduction Therapy With Onyx (A) Three-chamber cine-mode image before septal embolization during ventricular systole demonstrating systolic anterior motion with mitral regurgitation and LVOT obstruction. (B) Three-chamber cine-mode image after septal reduction therapy during ventricular systole demonstrating absence of mitral regurgitation and LVOT obstruction. (C) Three-chamber late enhancement (LVOT). Note the absence of late enhancement before septal reduction therapy. (D) Three-chamber late enhancement (LVOT). Note the presence of late enhancement in the anteroseptal segment of the basal portions of the left ventricle after septal reduction therapy. LVOT = left ventricular outflow tract.

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  Visual Summary. Key Insights From Septal Embolization With EVOH in HCM ECG = electrocardiogram; EVOH = ethylene and vinyl alcohol copolymer; HCM = hypertrophic cardiomyopathy; HOCM = hypertrophic obstructive cardiomyopathy.