The heart is a beating muscle that continually pumps blood to the lungs and organs of the body. Inside the heart are four chambers: two upper chambers, or atria, and two lower chambers, or ventricles. The ventricular septum is the muscle which separates the two ventricles.
Hypertrophic Cardiomyopathy (HCM) is a genetic heart disease where there is increased thickness of the left ventricle, predominantly affecting the ventricular septum. There are two types of HCM—nonobstructive and obstructive.
Obstructive HCM occurs when the mitral valve makes an abnormal motion and contacts the thickened septum, obstructing the flow of blood from the left ventricle out of the heart, as well as causing leakiness (or regurgitation) of blood back into the left atrium. This obstruction to blood flow and mitral regurgitation creates high pressures in the heart and is the main cause of limiting symptoms in patients with obstructive HCM. Symptoms may include: shortness of breath with exertion, chest pain, dizziness, or exertional fatigue. Although there is no cure for HCM, there are several effective treatment options available to improve symptoms.
Alcohol septal ablation is a minimally-invasive catheter-based treatment performed to reduce the thickening of the heart muscle, specifically the ventricular septum. During this procedure, the femoral artery is accessed and a catheter is advanced from the leg until it reaches the coronary artery supplying blood to the thickened septum. Once the catheter is properly positioned in the septal artery, a tiny balloon at the tip of the catheter is inflated, blocking blood flow. 1-2 cc of absolute alcohol is then injected through the catheter and into the septal artery. The alcohol directly damages the heart muscle which, over the course of several weeks to months, will reduce the thickness of the septum.
By thinning this area, the mitral valve will not move toward the septum, eliminating obstruction to blood flow. This restores the pressures in the heart to normal, resulting in a significant improvement or elimination of heart failure symptoms.
It can take several weeks to months for the septum to completely thin and the full benefits of the procedure to be felt.
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