Hypertrophic Obstructive Cardiomyopathy (HOCM) or idiopathic hypertrophic subaortic stenosis (IHSS) is characterized by an abnormal arrangement of the myocardial cells, which instead of lying in parallel rows, form whorl-like patterns. It most commonly affects the interventricular septum, but may also involve the entire myocardium or occur in isolated areas undetectable except by detailed histopathologic examination.
Subscribe in a reader Alcohol septal ablation, introduced by Ulrich Sigwart in 1994, is a percutaneous technique that involves injection of alcohol into one or more septal branches of the left anterior descending artery. This is a technique with results similar to the surgical septal myectomy procedure but is less invasive, since it does not involve general anaesthesia and opening of the chest wall and pericardium (which are done in a septal myomectomy). In a select population with symptoms secondary to a high outflow tract gradient, alcohol septal ablation can reduce the symptoms of HCM. In addition, older individuals and those with other medical problems, for whom surgical myectomy would pose increased procedural risk, would likely benefit from the lesser invasive septal ablation procedure..
When performed properly, an alcohol septal ablation induces a controlled heart attack, in which the portion of the interventricular septum that involves the left ventricular outflow tract is infarcted and will contract into a scar. Which patients are best served by surgical myectomy, alcohol septal ablation, or medical therapy is an important topic and one which is intensely debated in medical scientific circles
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