title: Pathological effects of alcohol septal ablation for hypertrophic obstructive cardiomyopathy.
abstract: BACKGROUND
  The pathological effects and the mechanisms of action of intracoronary administration of ethanol for alcohol septal ablation (ASA) for the management of hypertrophic obstructive cardiomyopathy (HOCM) are unknown.
  
  
  METHODS
  We examined surgical specimens and, in one case, autopsy specimens from four patients who underwent surgical septal myectomy 2 days to 14 months after unsuccessful ASA.
  
  
  RESULTS
  Pathological examination early after ASA showed coagulative necrosis of both the myocardium and the septal perforator arteries. Affected arteries were distended and occluded by necrotic intraluminal debris, without platelet-fibrin thrombi. Late after unsuccessful ASA, excised septal tissue was heterogeneous, containing a region of dense scar, and adjacent tissue containing viable myocytes and interspersed scar.
  
  
  CONCLUSIONS
  Intracoronary administration of ethanol in patients with HOCM causes acute myocardial infarction with vascular necrosis. The coagulative necrosis of the arteries, their distension by necrotic debris and the absence of platelet-fibrin thrombi distinguish ethanol-induced infarction from that caused by atherosclerotic coronary artery disease. The direct vascular toxicity of ethanol may be an important aspect of the mechanism of successful ASA.
authors.affiliation: Department of Medicine, Massachusetts General Hospital, Boston, Massachusetts, USA.
authors.forename: A L
authors.initials: AL
authors.lastname: Baggish
authors.forename: R N
authors.initials: RN
authors.lastname: Smith
authors.forename: I
authors.initials: I
authors.lastname: Palacios
authors.forename: G J
authors.initials: GJ
authors.lastname: Vlahakes
authors.forename: D M
authors.initials: DM
authors.lastname: Yoerger
authors.forename: M H
authors.initials: MH
authors.lastname: Picard
authors.forename: P A
authors.initials: PA
authors.lastname: Lowry
authors.forename: I-K
authors.initials: IK
authors.lastname: Jang
authors.forename: M A
authors.initials: MA
authors.lastname: Fifer
mesh_terms: D000293:Adolescent; D000328:Adult; D000368:Aged; D000369:Aged, 80 and over; D002312:Cardiomyopathy, Hypertrophic / Q000473:pathology / Q000628:therapy*; D000431:Ethanol / Q000008:administration & dosage* / Q000009:adverse effects; D005260:Female; D006801:Humans; D015552:Injections, Intralesional; D008297:Male; D008875:Middle Aged; D012597:Sclerosing Solutions / Q000008:administration & dosage* / Q000009:adverse effects; D017211:Treatment Failure
chemical_list: D012597:Sclerosing Solutions; D000431:Ethanol