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Published on: September 9, 2020
Microvascular permeability changes might explain cardiac tamponade after alcohol septal ablation for hypertrophic
Jen-Te Hsu1, Ju-Feng Hsiao1, Jung-Jung Chang1
1Department of Cardiology, Chiayi Chang Gung Memorial Hospital, Chang Gung University College of Medicine, Pu-Tz City, Chai Yi Hsien 61363, Taiwan.
Insights
Cardiac tamponade after alcohol septal ablation can occur due to increased microvascular permeability, not just trauma. This finding helps explain unexplained effusions following the procedure.
Area of Science:
- Cardiology
- Interventional Cardiology
Background:
- Alcohol septal ablation is a treatment for hypertrophic obstructive cardiomyopathy.
- Cardiac tamponade is a known, though infrequent, complication.
Observation:
- A case of a 78-year-old woman with hypertrophic obstructive cardiomyopathy who developed cardiac tamponade one hour post-alcohol septal ablation.
- A significant difference in red blood cell-to-white blood cell ratio was observed between pericardial effusion and peripheral blood.
Findings:
- The patient's cardiac tamponade was likely not due to mechanical trauma.
- A proposed mechanism involves alcohol-induced changes in microvascular permeability leading to effusion.
Implications:
- This suggests a novel explanation for acute, massive pericardial effusions after alcohol septal ablation.
- Understanding this mechanism may improve patient management and risk assessment for this procedure.
Abstract:
Various sequelae of alcohol septal ablation for hypertrophic obstructive cardiomyopathy have been reported. Of note, some cases of cardiac tamponade after alcohol septal ablation cannot be well explained. We describe the case of a 78-year-old woman with hypertrophic obstructive cardiomyopathy in whom cardiac tamponade developed one hour after alcohol septal ablation, probably unrelated to mechanical trauma. At that time, we noted a substantial difference in the red blood cell-to-white blood cell ratio between the pericardial effusion (1,957.4) and the peripheral blood (728.3). In addition to presenting the patient's case, we speculate that a possible mechanism for acute tamponade--alcohol-induced changes in microvascular permeability--is a reasonable explanation for cases of alcohol septal ablation that are complicated by otherwise-unexplainable massive pericardial effusions.
