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Myocardial infarction after percutaneous transluminal septal myocardial ablation in hypertrophic obstructive cardiomyopathy: evaluation by contrast-enhanced magnetic resonance imaging

Willem G. van Dockum, MD^*,*, Folkert J. ten Cate, MD, PhD, Jurrien M. ten Berg, MD, PhD^||, Aernout M. Beek, MD^*, Jos W. R. Twisk, PhD, Jeroen Vos, MD, Mark B. M. Hofman, PhD, Cees A. Visser, MD, PhD^* and Albert C. van Rossum, MD, PhD^*

^* Department of Cardiology, VU University Medical Center, Amsterdam, The Netherlands
Department of Clinical Epidemiology and Biostatistics, VU University Medical Center, Amsterdam, The Netherlands
Department of Clinical Physics and Informatics, VU University Medical Center, Amsterdam, The Netherlands
Department of Cardiology, Thoraxcenter Erasmus Medical Center, Rotterdam, The Netherlands
^|| Department of Cardiology, St. Antonius Hospital, Nieuwegein, The Netherlands

View larger version (106K): [in a new window]   Figure 1 Contrast-enhanced short-axis images before (A) and after percutaneous transluminal septal myocardial ablation (PTSMA) (B) in a patient with hypertrophic obstructive cardiomyopathy. Before PTSMA, a slightly enhanced myocardial region is apparent in the anterobasal wall of the interventricular septum. After PTSMA, the ethanol-induced infarction can be seen as a clearly demarcated area of hyperenhancement.

View larger version (129K): [in a new window]   Figure 2 Contrast-enhanced images 20 min after intravascular administration of gadolinium-DTPA in two patients with hypertrophic obstructive cardiomyopathy one month after percutaneous transluminal septal myocardial ablation. (A, B) Three-chamber view and short-axis view in a patient with transmural septal infarction. (C, D) Comparable views in a patient with myocardial infarction located exclusively on the right ventricular side of the interventricular septum.

View larger version (19K): [in a new window]   Figure 3 Correlation of myocardial infarction size and peak creatine phosphokinase (CK)-MB, reduction in septal mass, and the reduction in the left ventricular outflow tract (LVOT) pressure gradient after percutaneous transluminal septal myocardial ablation. The age-adjusted standardized regression coefficient (ß) and the significance (p value) are given. SEE = standard error of the estimate.

View larger version (11K): [in a new window]   Figure 4 Correlation of the volume of ethanol (ml) injected and myocardial infarction size (g) after percutaneous transluminal septal myocardial ablation. The age-adjusted standardized regression coefficient (ß) and the significance (p value) are given.