Pathological effects of alcohol septal ablation for hypertrophic obstructive cardiomyopathy

Heart
A L BaggishMichael A Fifer

Abstract

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. 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. 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. 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.

References

Jul 15, 2009·Molecular & Cellular Proteomics : MCP·Hasmik KeshishianSteven A Carr
Feb 28, 2009·Artificial Organs·Petronio G ThomazNoedir A G Stolf
Dec 1, 2010·Circulation Journal : Official Journal of the Japanese Circulation Society·Angelos G Rigopoulos, Hubert Seggewiss
May 25, 2011·Scandinavian Cardiovascular Journal : SCJ·Morten Kvistholm JensenHenning Bundgaard
Jul 15, 2009·Cardiovascular Revascularization Medicine : Including Molecular Interventions·Neeraj Parakh, Balram Bhargava
Jul 7, 2009·The American Journal of Cardiology·Peter A NoseworthySaumya Das
Apr 19, 2016·Ultrasound in Medicine & Biology·Xiaofang LuOliver D Kripfgans
Jun 9, 2016·Clinical Research in Cardiology : Official Journal of the German Cardiac Society·Angelos G RigopoulosHubert Seggewiss
Jul 2, 2008·Circulation·Paul SorajjaDavid R Holmes
Jan 24, 2008·Circulation·Michael A Fifer, Gus J Vlahakes
Nov 21, 2017·Journal of Therapeutic Ultrasound·Douglas L MillerOliver D Kripfgans

Citations

Oct 1, 1992·Hepatology : Official Journal of the American Association for the Study of Liver Diseases·M OshitaS Kawano
Mar 1, 1989·Circulation·P BrugadaH J Wellens
Dec 1, 1987·Journal of the American College of Cardiology·H InoueD P Zipes
Jan 1, 1996·Acta neurochirurgica·H KobayashiT Kubota
Oct 24, 1998·Journal of Cardiovascular Electrophysiology·K N WrightG N Kay
Jun 11, 1999·The Thoracic and Cardiovascular Surgeon·Hubert SeggewissU Gleichmann
Sep 15, 2000·Journal of the American College of Cardiology·Nasser M LakkisWilliam H Spencer
Jan 13, 2001·Mayo Clinic Proceedings·R P VillarealJ M Wilson
Jul 14, 2001·Journal of the American College of Cardiology·K TsuchihashiAngina Pectoris-Myocardial Infarction Investigations in Japan
Jun 19, 2003·Pathology, Research and Practice·Ute Raute-Kreinsen

Related Concepts

Fibrin Measurement
Necrosis
Ethanol
Arterial System
Necrotic Debris
Ethanol Measurement
Coronary Artery Disease
Autopsy
Muscle Cells
Hypertrophic Cardiomyopathy

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