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- Coronary artery disease (CAD)
- CT scanning
- stable angina
- heart rate variability
- oxidative stress
- risk factors
- cardiac catheterisation
- interventional cardiology
- heart failure treatment
- non-coronary intervention
- cardiomyopathy hypertrophic
Alcohol septal ablation (ASA) is an established alternative to surgical myectomy for the relief of left ventricular outflow tract obstruction in patients with hypertrophic obstructive cardiomyopathy1 and has been shown to improve New York Heart Association class and exercise tolerance, and to reduce outflow tract gradients.2
ASA is a percutaneous technique necessitating catheterisation of the left coronary artery. To identify the area of myocardium to be ablated, a proximal septal branch is wired, and an over-the-wire balloon is inflated to occlude flow and prevent reflux of contrast. Echocardiography contrast is injected through the lumen of the balloon, and the highlighted myocardium is assessed.
CT coronary angiography (CTCA) is a non-invasive imaging technique uniquely placed to identify simultaneous arterial and myocardial anatomy. We describe two case reports of the use of CTCA to determine anatomical suitability for ASA.
CTCA was performed using a Philips Brilliance 64-slice scanner using a helical protocol and 80 ml of intravenous contrast (Iomeron 400). In addition to identifying the proximal septal perforator, it was possible to assess whether the area supplied was equivalent to the area of maximum flow acceleration and the area of maximal systolic anterior movement of the mitral valve leaflets. These images were compared with transesophageal echocardiography and intra-arterial contrast injection performed at the time of invasive cardiac catheterisation (figures 1 and 2).
We propose that CTCA may be used in the assessment of suitability for ASA and, as it shows arterial and myocardial anatomy, offers incremental advantages over pre-procedure invasive coronary angiography.
Provenance and peer review Not commissioned; internally peer reviewed.
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