Contrast echocardiography with a physiological contrast agent for alcohol septal ablation

Myocardial contrast echocardiography in alcohol septal ablation (ASA) is critical prior to alcohol injection into the target septal artery branch. However, current contrast agents are expensive, carry the risk of anaphylaxis reaction, and are widely unavailable. Against this background, in this study, we introduce a practical solution for the assessment of target septal arteries by using physiological, practical, and safer intracoronary injections.

This study included 14 patients (8 females, 6 males), with symptomatic hypertrophic obstructive cardiomyopathy who underwent ASA between the years 2017 and 2025. Because of the unavailability and the high cost of contrast agents in our country, we used practical physiological agents, which comprised a cocktail fluid (agitated 5 mL of saline plus 0.5 mL blood of the patient). We injected ethanol (absolute alcohol 96%-99%) into the target perforatory artery using transesophageal echocardiography (TEE) in a step-by-step manner to observe a reduction in mitral regurgitation and QT prolongation at electrocardiographic monitorization (initially, 0.5 mL alcohol, then by increasing the dosage up to 3 mL).

We clearly obtained a good myocardial opacification of the interventricular basal septum border with our cocktail contrast agent. Furthermore, we used TEE in the ASA procedure, unlike other researchers who reported on this procedure. No arrhythmias and allergic reactions were recorded during the administration of the contrast agent. The mean dose of alcohol administered during ASA was 2.1 ± 0.7 mL. The procedural rate of success was highest (100%). We assessed the effectiveness of the treatment in terms of a reduction of the peak left ventricular outflow tract gradient and the disappearance of severe mitral regurgitation with a significantly systolic anterior motion.

The use of a physiological cocktail fluid in TEE exemplifies the use of a practical, alternative myocardial contrast agent for alcohol septal ablation.