Usefulness of selective myocardial contrast echocardiography in percutaneous transluminal septal myocardial ablation - A case report

A 67-year-old woman with hypertrophic obstructive cardiomyopathy that was r efractory to medical treatment underwent percutaneous transluminal septal m yocardial ablation (PTSMA). The septal branch supplying the myocardium invo lved in the left ventricular outflow tract (LVOT) obstruction was identifie d by selective myocardial contrast echocardiography (MCE). MCE for the thir d and largest septal branch opacified the right side of the mid-septal myoc ardium and MCE for the second septal branch opacified the right side of the basal portion of the septal myocardium. Finally, contrast agent was inject ed into the first, small branch, which opacificied the myocardium protrudin g into the LVOT. Subsequently, septal myocardial ablation for this vessel w ith intracoronary alcohol was performed, followed by a reduction of the LVO T gradient and successful, dramatic improvement in the patient's clinical c ondition. Selective MCE was very useful to identify the appropriate septal branch for PTSMA and enabled maximal effect of this treatment with minimal myocardial damage.