MYOCARDIAL PERFUSION AND METABOLISM AFTER TRANSCORONARY ABLATION OF SEPTUM HYPERTROPHY (TASH) IN HYPERTROPHIC OBSTRUCTIVE CARDIOMYOPATHY

Outflow obstruction constitutes a major problem in hypertrophic obstru ctive cardiomyopathy (HOCM) and may be treated by transcoronary inject ion of ethanol into septal arteries (transcoronary ablation of septum hypertrophy, TASH). We report on myocardial perfusion and glucose meta bolism in a 50 year old man in whom TASH led to a reduction of septal thickness (9 vs. 26 mm), a sustained elimination of the outflow tract obstruction (resting gradient 0 vs. 60 mmHg; post-ES-gradient 10 vs. 1 45 mmHg) and a substantial clinical improvement (NYHA stage II vs. II- III) without impairment of global ventricular function (left ventricul ar ejection fraction 0.62 vs. 0.64). After TASH, perfusion and glucose metabolism were assessed by positron emission tomography (PET) using F-18-fluorodeoxyglucose (F-18-FDG) and Tc-99m-MIBI single photon emiss ion tomography (SPECT). TASH results in matched reduction of perfusion and glucose consumption in a circumscribed area fed by the septal bra nch used for ethanol injection. No remote effects were observed. TASH leads to a sharply delineated septal reduction of perfusion and metabo lism with consecutive reduction of septal thickness, a sustained elimi nation of the outflow tract obstruction, and a substantial clinical im provement without impairment of global ventricular function.