Contrast Echocardiography to Evaluate Myocardial Perfusion During Percutaneous Transluminal Septal Myocardial Ablation

Background: Contrast echocardiography is frequently used to enhance endocardyal definition, Doppler signals, and to assess myocardial perfusion in percutaneous transluminal septal myocardial ablation.
Material and method: We followed clinically and echocardiographic 5 female patients with Septal Obstructive Hypertrophic Cardiomyopathy, which observed symptoms despite undergoing maximal medical therapy – angina, functional class NYHA III dyspnea, which underwent septal alcohol ablation. Clinical and echocardiographical examinations were performed at admission, before, during and after the procedure, at discharge, at 6 months and at 1 year. During the ablation contrast echocardiography was used.
Results: Maximum subaortic gradient was reduced by 30 mmHg in all cases, immediately after the procedure, with no increase in further examinations and reduced mitral regurgitation (grade I or minor after the procedure). Symptoms resolved in all patients with NYHA functional class I transition. Transient complications of the procedure in the first 24 hours after ablation were paroxysmal atrial fibrillation in 2 cases, atrioventricular block 2nd degree in 1 case and 3rd degree in 2 cases. Permanent complications were right bundle branch block 3 cases, left bundle branch block 1 case, 1st degree atrioventricular block 1 case.
Conclusions: All 5 patients opted for percutaneous transluminal septal myocardial ablation, although, according to guidelines, they had indication for septal myomectomy. Contrast echocardiography has proven to be a useful addition to percutaneous transluminal septal myocardial ablation.