Septal Reduction Therapy: Thinking Beyond the Conventional
- 1Department of Cardiology, Taguatinga Heart Institute (ICTCOR), Brasilia, DF, Brazil
Abstract
For patients with obstructive hypertrophic cardiomyopathy who are refractory to medical treatment, the surgical myectomy is the treatment of choice, but for some patients, alcohol septal ablation (ASA) is an alternative. In the following case report, we described a patient that underwent ASA, but during the follow-up, the gradient came back. This patient did not have septal branches from left anterior descending artery; therefore, she underwent ablation of a marginal branch of the left circumflex artery using an ethylene-vinyl alcohol copolymer guided by evaluation of the invasive gradient (echocardiogram was not performed during the procedure). One year later, the patient presented with refractory symptoms, and color Doppler echocardiography revealed a mean resting left ventricle outflow tract (LVOT) gradient of 72 mm Hg, a basal septum thickness of 21 mm, and a mid- and apical-septal thickness of 10 mm. Coronary angiography showed a pattern similar to that observed at the end of the marginal branch occlusion procedure. A transcatheter treatment attempt was proposed to identify the vessel supplying the basal septum for potential ablation; however, the patient opted for surgical myomectomy, which was performed successfully and without complications. She was discharged on the fifth day of hospitalization. Based on this case, we conclude that septal ablation should not be performed without an echocardiographic assessment during the procedure, other branches than the septal branches may supply the interventricular septum (if ablation of these branches is performed, it must be as selective as possible), and the reduction of the invasive LVOT gradient should not be used as the sole criterion for deciding which branch to occlude.
Related
- Percutaneous endomyocardial ablation as a septal reduction strategy in symptomatic obstructive hypertrophic cardiomyopathy: A 20-year single-center observational experience.
- Diastolic Function in Hypertensive Patients with Basal Septal Hypertrophy Assessed by Conventional Methods and Diastolic Strain Rate: A Single-Center Cross-Sectional Study
- Comparative Strain Trajectories After Septal Myectomy, Alcohol Septal Ablation, and Myosin Inhibitor Therapy.
- Serial 4-Dimensional Flow Cardiac Magnetic Resonance Imaging Visualizes Incremental Hemodynamic Improvement Following Alcohol Septal Ablation and Subsequent Mavacamten Therapy
- P081 Thinking beyond the temporal artery: an atypical presentation of giant cell arteritis
BibTeX
@article{motta2026septal,
title = {{Septal Reduction Therapy: Thinking Beyond the Conventional}},
author = {Paulo Antonio Marra da Motta and Bernardo Drummond Motta and Carolina Gomes Cavalcanti de Oliveira and Fabricio Caied and Ernesto Misael Cintra Osterne and Thomas Edson Cintra Osterne and Evandro Cesar Vidal Osterne and Dinaldo Cavalcanti de Oliveira},
journal = {Cardiology research},
year = {2026},
month = oct,
doi = {10.14740/cr2332},
url = {https://europepmc.org/article/PMC/PMC13719644},
note = {CC BY},
}
RIS
TY - JOUR
TI - Septal Reduction Therapy: Thinking Beyond the Conventional
AU - Paulo Antonio Marra da Motta
AU - Bernardo Drummond Motta
AU - Carolina Gomes Cavalcanti de Oliveira
AU - Fabricio Caied
AU - Ernesto Misael Cintra Osterne
AU - Thomas Edson Cintra Osterne
AU - Evandro Cesar Vidal Osterne
AU - Dinaldo Cavalcanti de Oliveira
PY - 2026
DA - 2026/10/24
JO - Cardiology research
DO - 10.14740/cr2332
UR - https://europepmc.org/article/PMC/PMC13719644
AB - For patients with obstructive hypertrophic cardiomyopathy who are refractory to medical treatment, the surgical myectomy is the treatment of choice, but for some patients, alcohol septal ablation (ASA) is an alternative. In the following case report, we described a patient that underwent ASA, but during the follow-up, the gradient came back. This patient did not have septal branches from left anterior descending artery; therefore, she underwent ablation of a marginal branch of the left circumflex artery using an ethylene-vinyl alcohol copolymer guided by evaluation of the invasive gradient (echocardiogram was not performed during the procedure). One year later, the patient presented with refractory symptoms, and color Doppler echocardiography revealed a mean resting left ventricle outflow tract (LVOT) gradient of 72 mm Hg, a basal septum thickness of 21 mm, and a mid- and apical-septal thickness of 10 mm. Coronary angiography showed a pattern similar to that observed at the end of the marginal branch occlusion procedure. A transcatheter treatment attempt was proposed to identify the vessel supplying the basal septum for potential ablation; however, the patient opted for surgical myomectomy, which was performed successfully and without complications. She was discharged on the fifth day of hospitalization. Based on this case, we conclude that septal ablation should not be performed without an echocardiographic assessment during the procedure, other branches than the septal branches may supply the interventricular septum (if ablation of these branches is performed, it must be as selective as possible), and the reduction of the invasive LVOT gradient should not be used as the sole criterion for deciding which branch to occlude.
SN - 1923-2829
SN - 1923-2837
ER -