PT  - JOURNAL ARTICLE
AU  - A L Baggish
AU  - R N Smith
AU  - I Palacios
AU  - G J Vlahakes
AU  - D M Yoerger
AU  - M H Picard
AU  - P A Lowry
AU  - I-k Jang
AU  - M A Fifer
TI  - Pathological effects of alcohol septal ablation for hypertrophic obstructive cardiomyopathy
AID  - 10.1136/hrt.2006.092007
DP  - 2006 Dec 01
TA  - Heart
PG  - 1773--1778
VI  - 92
IP  - 12
4099  - http://heart.bmj.com/content/92/12/1773.short
4100  - http://heart.bmj.com/content/92/12/1773.full
SO  - Heart2006 Dec 01; 92
AB  - Background: The pathological effects and the mechanisms of action of intracoronary administration of ethanol for alcohol septal ablation (ASA) for the management of hypertrophic obstructive cardiomyopathy (HOCM) are unknown. Methods: We examined surgical specimens and, in one case, autopsy specimens from four patients who underwent surgical septal myectomy 2 days to 14 months after unsuccessful ASA. Results: Pathological examination early after ASA showed coagulative necrosis of both the myocardium and the septal perforator arteries. Affected arteries were distended and occluded by necrotic intraluminal debris, without platelet–fibrin thrombi. Late after unsuccessful ASA, excised septal tissue was heterogeneous, containing a region of dense scar, and adjacent tissue containing viable myocytes and interspersed scar. Conclusions: Intracoronary administration of ethanol in patients with HOCM causes acute myocardial infarction with vascular necrosis. The coagulative necrosis of the arteries, their distension by necrotic debris and the absence of platelet–fibrin thrombi distinguish ethanol-induced infarction from that caused by atherosclerotic coronary artery disease. The direct vascular toxicity of ethanol may be an important aspect of the mechanism of successful ASA.