Alcohol septal ablation (ASA) is a minimally invasive procedure used to treat hypertrophic cardiomyopathy (HCM), a genetic condition characterized by abnormal thickening of the heart muscle (myocardium), particularly the ventricular septum—the wall that separates the two lower chambers of the heart (ventricles).
During an alcohol septal ablation:
Preparation: The patient is typically given sedation or anesthesia to ensure comfort during the procedure. The procedure is often performed in a catheterization laboratory (cath lab) or hybrid operating room.
Insertion of the Catheter: A catheter is inserted into a blood vessel, usually in the groin or wrist, and guided to the heart under X-ray or ultrasound guidance.
Identification of the Septal Artery: Once the catheter reaches the area of the heart with the thickened septum, a special dye is injected through the catheter to visualize the septal artery, which supplies blood to the thickened portion of the septum.
Delivery of Alcohol: After the septal artery is identified, a small amount of pure alcohol is injected through the catheter into the septal artery. The alcohol causes controlled damage to the septal tissue, reducing the thickness of the septum and relieving symptoms of HCM.
Monitoring and Recovery: After the alcohol is injected, the catheter is removed, and pressure is applied to the insertion site to prevent bleeding. The patient is monitored closely for a short period before being discharged.
Alcohol septal ablation is an alternative to surgical septal myectomy, which involves open-heart surgery to remove a portion of the thickened septum. ASA is typically recommended for individuals with obstructive HCM who have symptoms such as chest pain (angina), shortness of breath, or heart failure that are not well controlled with medications. The procedure can help alleviate symptoms, improve exercise capacity, and reduce the gradient of pressure across the obstructed septum.