[Alcohol concentration in the coronary sinus after transarterial ablation of septal hypertrophy in hypertrophic obstructive cardiomyopathy].
OBJECTIVE
The size of the resulting myocardial necrosis varies after percutaneous transarterial ablation (PTA) of hypertrophied septum in patients with hypertrophic obstructive cardiomyopathy (HOCM). It was the aim of this study to discover whether the alcohol concentration in coronary sinus (CS) blood is a useful and appropriate parameter and what conclusions can be drawn from it.


METHODS
PTA was done in four patients (two women and two men, aged 30-53 years) with HOCM. Before the intervention the gradient across the left ventricular outflow tract ranged form 20 to 80 mmHg, postextrasystolic it ranged from 40 to 180 mmHg. 1 x 2 ml ethanol was injected into the first septal branch in 3 patients, 2 x 2 ml in one. The alcohol concentration in coronary sinus blood was measured every 30 sec for up to 5 min before and after ablation. The amounts were compared with the size of the akinetic area in the echocardiogram and the maximal value of creatine kinase, as a measure of the size of myocardial necrosis.


RESULTS
The left ventricular outflow gradient was reduced in all patients, to 0-30 mmHg and postextrasystolic to 30-90 mmHg. A pacemaker had to be implanted in one patient who developed a 3 degrees AV block. The alcohol concentration in coronary sinus blood ranged from maximally 1.53 and 0.23 per thousand after 30 sec and then fell to 0.56-0.12 per thousand after 5 min. The patient with the highest CS alcohol concentration also had the highest maximal value for creatine kinase (68 mumol/l) and the largest akinetic area in the echocardiogram.


CONCLUSIONS
The extent of myocardial necrosis can probably be estimated from the CS blood concentration of alcohol after alcohol ablation. If, after the first injection, high alcohol concentrations are measured, further alcohol injections are not indicated.
Klein
N
N
Medizinische Klinik und Poliklinik, Abteilung Kardiologie, Universität Leipzig.
Mende
M
M
Hagendorff
A
A
Neugebauer
A
A
Pfeiffer
D
D
D000328:Adult; D002312:Cardiomyopathy, Hypertrophic / Q000097:blood / Q000601:surgery*; D017115:Catheter Ablation; D003331:Coronary Vessels / Q000378:metabolism; D003402:Creatine Kinase / Q000097:blood; D004452:Echocardiography / Q000187:drug effects; D000431:Ethanol / Q000097:blood* / Q000627:therapeutic use; D005260:Female; D006346:Heart Septum / Q000601:surgery*; D006801:Humans; D008297:Male; D008875:Middle Aged; D009200:Myocardial Contraction / Q000187:drug effects; D016896:Treatment Outcome; D014694:Ventricular Outflow Obstruction / Q000097:blood / Q000601:surgery*
D000431:Ethanol; D003402:Creatine Kinase