title: Cardiac MRI detected septal and lateral myocardial infarction by alcohol septal ablation through the intermediate artery.
abstract: A 65-year-old woman with hypertrophic obstructive cardiomyopathy presented with dyspnea. Transthoracic echocardiography showed severe mitral regurgitation (MR) due to systolic anterior motion and a peak gradient of 102 mmHg across the LV outflow. Cardiac magnetic resonance imaging (CMR) showed patchy late gadolinium enhancement in the hypertrophied septum. Because of non-responsiveness to medical treatment, percutaneous alcohol septal ablation (ASA) was conducted. The septal perforator that supplied the hypertrophic myocardium originated from the intermediate artery. A 2.0-mm over-the-wire balloon was used to occlude the intermediate artery and 1.1 ml of ethanol was injected slowly into the target septal perforator branch. The gradient decreased markedly to 5 mmHg immediately after ASA, and electrocardiogram showed right bundle branch block. Echocardiographic findings at 1 week were satisfactory. However, CMR showed delayed enhancement in both the hypertrophic basal septum and the lateral wall. The clinical course was uneventful, and she has maintained NHYA functional class 1 so far. In this case, proximal migration of the balloon or an undersized occluding balloon may have caused lateral infarction through leakage of ethanol into another branch. CMR is a useful modality to verify whether the ASA procedure has induced the appropriate controlled infarction.
authors.affiliation: Department of Cardiology, Sakakibara Heart Institute, 3-16-1 Asahi-cho, Fuchu, Tokyo, 183-0003, Japan, msaji@shi.heart.or.jp.
authors.forename: Mike
authors.initials: M
authors.lastname: Saji
authors.forename: Itaru
authors.initials: I
authors.lastname: Takamisawa
authors.forename: Nobuo
authors.initials: N
authors.lastname: Iguchi
authors.forename: Morimasa
authors.initials: M
authors.lastname: Takayama
mesh_terms: D055011:Ablation Techniques; D000368:Aged; D021721:Balloon Occlusion; D002312:Cardiomyopathy, Hypertrophic / Q000175:diagnosis / Q000628:therapy*; D017023:Coronary Angiography; D003331:Coronary Vessels; D004562:Electrocardiography; D000431:Ethanol / Q000008:administration & dosage*; D005260:Female; D006801:Humans; D007269:Injections, Intra-Arterial; D008279:Magnetic Resonance Imaging; D009203:Myocardial Infarction / Q000473:pathology*; D011237:Predictive Value of Tests; D016896:Treatment Outcome
chemical_list: D000431:Ethanol