Skip to main content
SpringerLink
Log in

Cardiac MRI detected septal and lateral myocardial infarction by alcohol septal ablation through the intermediate artery

  • Case Report
  • Published:
Heart and Vessels Aims and scope Submit manuscript

Abstract

A 65-year-old woman with hypertrophic obstructive cardiomyopathy presented with dyspnea. Transthoracic echocardiography showed severe mitral regurgitation (MR) due to systolic anterior motion and a peak gradient of 102 mmHg across the LV outflow. Cardiac magnetic resonance imaging (CMR) showed patchy late gadolinium enhancement in the hypertrophied septum. Because of non-responsiveness to medical treatment, percutaneous alcohol septal ablation (ASA) was conducted. The septal perforator that supplied the hypertrophic myocardium originated from the intermediate artery. A 2.0-mm over-the-wire balloon was used to occlude the intermediate artery and 1.1 ml of ethanol was injected slowly into the target septal perforator branch. The gradient decreased markedly to 5 mmHg immediately after ASA, and electrocardiogram showed right bundle branch block. Echocardiographic findings at 1 week were satisfactory. However, CMR showed delayed enhancement in both the hypertrophic basal septum and the lateral wall. The clinical course was uneventful, and she has maintained NHYA functional class 1 so far. In this case, proximal migration of the balloon or an undersized occluding balloon may have caused lateral infarction through leakage of ethanol into another branch. CMR is a useful modality to verify whether the ASA procedure has induced the appropriate controlled infarction.

This is a preview of subscription content, log in via an institution to check access.

Access this article

Log in via an institution

Price excludes VAT (USA)
Tax calculation will be finalised during checkout.

Instant access to the full article PDF.

Institutional subscriptions

Fig. 1
Fig. 2
Fig. 3
Fig. 4
Fig. 5
Fig. 6
Fig. 7
Fig. 8

References

  1. Kuhn H, Seggewiss H, Gietzen FH, Boekstegers P, Neuhaus L, Seipel L (2004) Catheter-based therapy for hypertrophic obstructive cardiomyopathy. First in-hospital outcome analysis of the German TASH Registry. Z Kardiol 93(1):23–31

    Article  PubMed  CAS  Google Scholar 

  2. Rivera S, Sitges M, Azqueta M, Marigliano A, Velamazan M, Miranda-Guardiola F, Betriu A, Pare C (2003) Left ventricular remodeling in patients with hypertrophic obstructive cardiomyopathy treated with percutaneous alcohol septal ablation: an echocardiographic study. Rev Esp Cardiol 56(12):1174–1181

    PubMed  Google Scholar 

  3. Sato T, Yamanari H, Ohe T, Yoshinouchi T (1996) Regional left ventricular contractile dynamics in hypertrophic cardiomyopathy evaluated by magnetic resonance imaging. Heart Vessels 11(5):248–254

    Article  PubMed  CAS  Google Scholar 

  4. Noble S, Frangos C, L’Allier PL (2012) Alcohol septal ablation for obstructive hypertrophic cardiomyopathy: the perfect septal branch may originate from an atypical location. Can J Cardiol 28(2):245.e1–245.e3

    Article  Google Scholar 

  5. Lakkis NM, Nagueh SF, Kleiman NS, Killip D, He ZX, Verani MS, Roberts R, Spencer WH 3rd (1998) Echocardiography-guided ethanol septal reduction for hypertrophic obstructive cardiomyopathy. Circulation 98(17):1750–1755

    Article  PubMed  CAS  Google Scholar 

  6. Nagueh SF, Lakkis NM, He ZX, Middleton KJ, Killip D, Zoghbi WA, Quinones MA, Roberts R, Verani MS, Kleiman NS, Spencer WH 3rd (1998) Role of myocardial contrast echocardiography during nonsurgical septal reduction therapy for hypertrophic obstructive cardiomyopathy. J Am Coll Cardiol 32(1):225–229

    Article  PubMed  CAS  Google Scholar 

  7. Monakier D, Woo A, Puri T, Schwartz L, Ross J, Jamorski M, Yang H, Liu Z, Vannan M, Wigle Rakowski H (2004) Usefulness of myocardial contrast echocardiographic quantification of risk area for predicting postprocedural complications in patients undergoing septal ethanol ablation for obstructive hypertrophic cardiomyopathy. Am J Cardiol 94(12):1515–1522

    Article  PubMed  Google Scholar 

  8. Faber L, Ziemssen P, Seggewiss H (2000) Targeting percutaneous transluminal septal ablation for hypertrophic obstructive cardiomyopathy by intraprocedural echocardiographic monitoring. J Am Soc Echocardiogr 13(12):1074–1079

    Article  PubMed  CAS  Google Scholar 

  9. Ruzyllo W, Chojnowska L, Demkow M, Witkowski A, Kusmierczyk-Droszcz B, Piotrowski W, Rausinska L, Karcz M, Malecka L, Rydlewska-Sadowska W (2000) Left ventricular outflow tract gradient decrease with non-surgical myocardial reduction improves exercise capacity in patients with hypertrophic obstructive cardiomyopathy. Eur Heart J 21(9):770–777

    Article  PubMed  CAS  Google Scholar 

  10. Kazmierczak J, Kornacewicz-Jach Z, Kisly M, Gil R, Wojtarowicz A (1998) Electrocardiographic changes after alcohol septal ablation in hypertrophic obstructive cardiomyopathy. Heart 80(3):257–262

    PubMed  CAS  Google Scholar 

  11. Alam M, Dokainish H, Lakkis N (2006) Alcohol septal ablation for hypertrophic obstructive cardiomyopathy: a systematic review of published studies. J Interv Cardiol 19(4):319–327

    Article  PubMed  Google Scholar 

  12. Seggewiss H, Gleichmann U, Faber L, Fassbender D, Schmidt HK, Strick S (1998) Percutaneous transluminal septal myocardial ablation in hypertrophic obstructive cardiomyopathy: acute results and 3-month follow-up in 25 patients. J Am Coll Cardiol 31(2):252–258

    Article  PubMed  CAS  Google Scholar 

  13. Fighali S, Krajcer Z, Leachman RD (1984) Septal myomectomy and mitral valve replacement for idiopathic hypertrophic subaortic stenosis: short- and long-term follow-up. J Am Coll Cardiol 3(5):1127–1134

    Article  PubMed  CAS  Google Scholar 

  14. Dimitrow PP, Dudek D, Dubeil JS (2001) The risk of alcohol leakage into the left anterior descending coronary artery during non-surgical myocardial reduction in patients with obstructive hypertrophic cardiomyopathy. Eur Heart J 22(5):437–438

    Article  PubMed  CAS  Google Scholar 

  15. Knight C, Kurbaan AS, Seggewiss H, Henein M, Gunning M, Harrington D, Fassbender D, Gleichmann U, Sigwart U (1997) Nonsurgical septal reduction for hypertrophic obstructive cardiomyopathy: outcome in the first series of patients. Circulation 95(8):2075–2081

    Article  PubMed  CAS  Google Scholar 

  16. Veselka J, Zemanek D, Tomasov P, Duchonova R, Linhartova K (2009) Alcohol septal ablation for obstructive hypertrophic cardiomyopathy: ultra-low dose of alcohol (1 ml) is still effective. Heart Vessels 24(1):27–31

    Article  PubMed  Google Scholar 

Download references

Author information

Authors and Affiliations

  1. Department of Cardiology, Sakakibara Heart Institute, 3-16-1 Asahi-cho, Fuchu, Tokyo, 183-0003, Japan

    Mike Saji, Itaru Takamisawa, Nobuo Iguchi & Morimasa Takayama

Authors
  1. Mike Saji
    View author publications

    You can also search for this author in PubMed Google Scholar

  2. Itaru Takamisawa
    View author publications

    You can also search for this author in PubMed Google Scholar

  3. Nobuo Iguchi
    View author publications

    You can also search for this author in PubMed Google Scholar

  4. Morimasa Takayama
    View author publications

    You can also search for this author in PubMed Google Scholar

Corresponding author

Correspondence to Mike Saji.

Rights and permissions

Reprints and permissions

About this article

Cite this article

Saji, M., Takamisawa, I., Iguchi, N. et al. Cardiac MRI detected septal and lateral myocardial infarction by alcohol septal ablation through the intermediate artery. Heart Vessels 28, 672–676 (2013). https://doi.org/10.1007/s00380-012-0317-7

Download citation

  • Received:

  • Accepted:

  • Published:

  • Issue Date:

  • DOI: https://doi.org/10.1007/s00380-012-0317-7

Keywords

Search

Navigation