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Reduction of Iatrogenic Atrial Septal Defects with an Anterior and Inferior Transseptal Puncture Site when Operating the Cryoballoon Ablation Catheter
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Pathological effects of alcohol septal ablation for hypertrophic obstructive cardiomyopathy

A L Baggish1, R N Smith, I Palacios

  • 1Department of Medicine, Massachusetts General Hospital, Boston, Massachusetts, USA.

Heart (British Cardiac Society)
|June 30, 2006
PubMed

Insights

Ethanol septal ablation for hypertrophic obstructive cardiomyopathy causes acute myocardial infarction and vascular necrosis. This ethanol-induced infarction differs from atherosclerotic disease, suggesting direct vascular toxicity is key to the procedure’s success.

Area of Science:

  • Cardiovascular Pathology
  • Interventional Cardiology

Background:

  • The mechanism of alcohol septal ablation (ASA) for hypertrophic obstructive cardiomyopathy (HOCM) is not fully understood.
  • Pathological effects of intracoronary ethanol administration require elucidation.

Observation:

  • Surgical and autopsy specimens from four patients post-ASA were examined.
  • Tissue analysis occurred 2 days to 14 months after unsuccessful ASA.

Findings:

  • Early post-ASA, coagulative necrosis of myocardium and septal arteries was observed.
  • Affected arteries showed distension and occlusion by necrotic debris, lacking thrombi.
  • Late specimens revealed heterogeneous scarring with viable myocytes.

Implications:

  • Intracoronary ethanol induces acute myocardial infarction with vascular necrosis in HOCM.
  • Ethanol-induced infarction is distinct from atherosclerotic infarction due to coagulative necrosis and lack of thrombi.
  • Direct vascular toxicity of ethanol is a likely mechanism for successful ASA.
Abstract

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