Alcohol Septal Ablation

#7

Cardiology

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Patients with hypertrophic obstructive cardiomyopathy have abnormally thickened walls of the the left ventricle, the heart's main pumping chamber. The interventricular septum — the wall of muscle between the two ventricles of the heart — is often excessively thickened. This thickened wall can interfere with the function of the mitral valve and can block the flow of blood out of the heart. The inefficient blood flow causes the pressure in the heart to increase, making the left ventricle work harder, resulting in further thickening of the walls of the left ventricle over time. Symptoms associated with HOCM can include chest pain, shortness of breath, palpitations, syncope (sudden fainting), and even sudden death.

Treatments for HOCM include medication to control the heart's contraction, insertion of pacemakers to prevent arrhythmias, and — when medications fail — surgical resection of the thickened septum, making it thinner. Interventional cardiologists at NewYork-Presbyterian Hospital offer alcohol septal ablation as an alternative to surgery in select patients. This relatively new treatment for HOCM actually reduces the obstruction and improves blood flow out of the heart. In addition, it often improves the function of the mitral valve.

During alcohol septal ablation, a balloon catheter is inserted in the groin and is led to the heart. With echocardiographic and/or fluoroscopic guidance, the catheter is led to the small artery that supplies the interventricular septum. A small amount of pure alcohol is introduced into the vessel. This results in carefully controlled damage to that part of the abnormally thickened septum. A thinner wall of scar tissue that reduces the obstruction and improves the overall function of the heart will replace the septum. Many patients feel immediate improvement of their symptoms; the majority continue to improve over many months.

Last modified: 05-26-2009