to the editor: Spratt and colleagues describe two cases in which they state that performing a Computed Tomography coronary angiography (CTCA) prior to alcohol septal ablation (ASA) may aid in the selection of the appropriate septal branch for ablation and patients suitable for ASA (1). Visualisation of a dominant septal perforator and its course in the myocardium with CTCA has been described previously (2). Importantly, CTCA has three important limitations being that it is unable to visualise due to limitation of resolution smaller proximal septal branches that can be the target vessel, that it is unable to visualise the perfusion area of the septum and that it cannot display the area of maximal flow acceleration. The combination of coronary angiography and contrast echocardiography has been shown to be superior for these purposes (3) and we therefore believe that performing additional CTCA prior to ASA does not give extra information.

reference 1) Spratt JC, Langrish JP. Identifying the target septal perforator prior to alcohol septal ablation in hypertrophic obstructive cardiomyopathy: a new application for computed tomography coronary angiography. Heart 2011; 97: 1718-1719. 2) Brinjikji W, Harris SR, Froemming AT, Christensen KN, Lachman N, Araoz PA. Descriptive anatomy of the dominant septal perforators using Dual Source CT angiography. Clin Anat 2010; 23(1): 70-8. 3) Faber L, Seggewiss H, Gleichmann U. Percutaneous septal myocardial ablation in hypertrophic obstructive cardiomyopathy: Results with respect to intraprocedural myocardial contrast echocardiography. Circulation 1998; 98: 2415-2421.

Conflict of Interest:

None declared