Alcohol septal ablation for hypertrophic obstructive cardiomyopathy in a patient with a chronic total occlusion of the right coronary artery: "beware of collateral damage".
Alcohol septal ablation (ASA) is an effective semi-invasive alternative to surgical myectomy in selected patients for the management of severely symptomatic and drug-refractory hypertrophic obstructive cardiomyopathy (HOCM). One contraindication of this procedure is the presence of collateral flow originating from the target septal perforator to a remote myocardial territory. In such circumstances, ethanol injection could cause remote non-target myocardial necrosis in the collateralized territory. Percutaneous revascularization of the collateralized vessel prior to ASA might cope with this contraindication by restoring normal antegrade flow in the occluded artery. We report a case that illustrates the feasibility and efficacy of such strategy.
Interventional Cardiology Department, Montreal Heart Institute, Université de Montréal, 5000 Belanger Street, Montreal, Québec H1T 1C8, Canada.
Quentin
Q
de Hemptinne
Interventional Cardiology Department, Montreal Heart Institute, Université de Montréal, 5000 Belanger Street, Montreal, Québec H1T 1C8, Canada.
Fabien
F
Picard
Interventional Cardiology Department, Montreal Heart Institute, Université de Montréal, 5000 Belanger Street, Montreal, Québec H1T 1C8, Canada.
Philippe L
PL
L'Allier
Alcohol septal ablation (ASA); chronic total occlusion (CTO); collateral damage; hypertrophic obstructive cardiomyopathy (HOCM)