GUIDING OF PERCUTANEOUS TRANSCORONARY SEPTAL MYOCARDIAL ABLATION IN HYPERTROPHIC OBSTRUCTIVE CARDIOMYOPATHY BY MYOCARDIAL CONTRAST ECHOCARDIOGRAPHY

Percutaneous transluminal septal myocardial ablation (PTSMA) by alcoho l injection into septal branches (SB) of the left coronary artery has evolved as a promising therapeutic option for selected patients with o bstructive hypertrophic cardiomyopathy (HOCM). Originally, probatory b alloon occlusion of the target vessel was considered to be predictive for definitive reduction of left ventricular outflow gradients (LVOTG) . The need for additional information regarding the exact site and ext ension of the therapeutic septal infarction is demonstrated by a case report. In this patient, myocardial contrast echocardiography (MCE) wa s performed prior to alcohol injection and showed that the septal area corresponding to LVOTG formation was supplied by a SE originating aty pically from an intermediate branch. PTSMA guided by MCE led to comple te LVOTG elimination without sustained rhythm disturbances and with a minimum CK rise.