title: Microvascular permeability changes might explain cardiac tamponade after alcohol septal ablation for hypertrophic cardiomyopathy.
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.
authors.affiliation: Department of Cardiology, Chiayi Chang Gung Memorial Hospital, Chang Gung University College of Medicine, Pu-Tz City, Chai Yi Hsien 61363, Taiwan.
authors.forename: Jen-Te
authors.initials: JT
authors.lastname: Hsu
authors.affiliation: Department of Cardiology, Chiayi Chang Gung Memorial Hospital, Chang Gung University College of Medicine, Pu-Tz City, Chai Yi Hsien 61363, Taiwan.
authors.forename: Ju-Feng
authors.initials: JF
authors.lastname: Hsiao
authors.affiliation: Department of Cardiology, Chiayi Chang Gung Memorial Hospital, Chang Gung University College of Medicine, Pu-Tz City, Chai Yi Hsien 61363, Taiwan.
authors.forename: Jung-Jung
authors.initials: JJ
authors.lastname: Chang
authors.affiliation: Department of Cardiology, Chiayi Chang Gung Memorial Hospital, Chang Gung University College of Medicine, Pu-Tz City, Chai Yi Hsien 61363, Taiwan.
authors.forename: Chang-Min
authors.initials: CM
authors.lastname: Chung
authors.affiliation: Department of Cardiology, Chiayi Chang Gung Memorial Hospital, Chang Gung University College of Medicine, Pu-Tz City, Chai Yi Hsien 61363, Taiwan.
authors.forename: Shih-Tai
authors.initials: ST
authors.lastname: Chang
authors.affiliation: Department of Cardiology, Chiayi Chang Gung Memorial Hospital, Chang Gung University College of Medicine, Pu-Tz City, Chai Yi Hsien 61363, Taiwan.
authors.forename: Kuo-Li
authors.initials: KL
authors.lastname: Pan
mesh_terms: D055011:Ablation Techniques / Q000009:adverse effects / Q000295:instrumentation / Q000379:methods; D000368:Aged; D002199:Capillary Permeability / Q000187:drug effects*; D002305:Cardiac Tamponade / Q000097:blood / Q000209:etiology / Q000503:physiopathology / Q000601:surgery; D002312:Cardiomyopathy, Hypertrophic / Q000175:diagnosis / Q000503:physiopathology / Q000628:therapy; D004322:Drainage / Q000379:methods; D004452:Echocardiography; D000431:Ethanol / Q000493:pharmacokinetics / Q000627:therapeutic use; D005260:Female; D006346:Heart Septum / Q000473:pathology; D006801:Humans; D010490:Pericardial Effusion / Q000209:etiology / Q000473:pathology / Q000503:physiopathology; D020519:Pericardiocentesis / Q000379:methods*; D010996:Pleural Effusion / Q000097:blood / Q000209:etiology / Q000503:physiopathology / Q000628:therapy; D016896:Treatment Outcome
chemical_list: D000431:Ethanol
keywords: Cardiac tamponade/etiology; cardiomyopathy, hypertrophic/complications/physiopathology/therapy; catheter ablation/adverse effects; ethanol/administration & dosage/adverse effects/therapeutic use; ventricular outflow obstruction/etiology