Septal Ablation for HOCM – A Case Study | Dr. C Raghu
Septal ablation for Hypertrophic Obstructive Cardiomyopathy
Dr C Raghu
Yashoda Hospital
Secunderabad Unit
Background
38-year male presented with
Giddy spells and breathlessness on minimal exertion – 3 months
Evaluated and diagnosed
Hypertrophic Obstructive Cardiomyopathy with severe LVOT obstruction-resting gradient 80 mm Hg
Referred for further management to Dr C Raghu Senior Interventional cardiologist-Clinical Director at Yashoda Hospital, Secunderabad Unit
- Who, when and where for septal ablation?
- Medication-refractory symptoms – NYHA class III/IV
- Younger patients or those with presyncope or syncope
- LVOT obstruction with gradient at rest greater then 30 or 50 mm Hg with provocable maneuvers
- Basal septal thickness meeting criteria for HCM (greater then 15 mm)
- Absence of a need for another open cardiac surgery (e.g., valve replacement or coronary artery bypass graft)
- Adequate volume and operator and institutional experience
- Adequate septal perforators in size and location to target the myocardium
Septal Ablation for HOCM (Hypertrophic Obstructive Cardiomyopathy): Overview
What is HOCM?
Hypertrophic Obstructive Cardiomyopathy (HOCM) is a genetic condition where the heart muscle, particularly the septum (the wall separating the left and right sides of the heart), becomes abnormally thick. This thickening can obstruct blood flow out of the heart, causing symptoms like shortness of breath, chest pain, fainting, or irregular heart rhythms.
What is Septal Ablation?
Septal ablation, also known as Alcohol Septal Ablation (ASA), is a minimally invasive procedure used to treat HOCM. It aims to reduce the thickness of the septum and improve blood flow by selectively destroying the excess heart muscle using alcohol.
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How is the Procedure Performed?
Preparation
The patient is given a local anesthetic or light sedation.
A catheter is inserted into an artery, usually in the groin, and guided to the heart.
Localization of the Target Area
A contrast dye is injected into the blood vessels supplying the thickened septal muscle to identify the area causing obstruction.
Injection of Alcohol
A small amount of alcohol is delivered through the catheter to the targeted blood vessel, which causes controlled damage (necrosis) to the thickened tissue.
Over time, this damaged tissue shrinks, reducing the obstruction.
Benefits of Septal Ablation
- Symptom relief (e.g., reduced shortness of breath, fatigue).
- Improved blood flow and quality of life.
- Less invasive alternative to surgical myectomy, with shorter recovery time.
Please refer your needy patients with Hypertrophic Cardiomyopathy
Dr C Raghu
MD:DM FACC FESC
Level 2 Master in Structural Heart Interventions
Senior Interventional Cardiologist
Clinical Director
Yashoda Hospital – Secunderabad Unit
