Percutaneous transluminal septal myocardial ablation for hypertrophic obstructive cardiomyopathy

was carefully introduced into a small branch perforating the hypertrophic site of the interventricular septum. Contrast agent produced using the manual agitation method was injected from the tip of the balloon catheter. Simultaneously, a left ventricular long-axis view from the cardiac apex was taken with a low gain setting of the ultrasonograph. The hypertrophic site of the interventricular septum was visualized as a brightened mass (Fig. 2) immediately after the echo contrast agent was injected. Ethanol was slowly injected through the tip of the balloon catheter superselectively inserted into the perforating branch of the LAD. During the follow-up period, reduction of the pressure gradient in the left ventricular outfl ow tract was demonstrated on continuous-wave Doppler fl owmetry and two-dimensional echocardiography (Fig. 3). Systolic anterior motion disappeared on M-mode echocardiography, although the aortic regurgitation jet image became clearer than that acquired at the time of the preoperative examination. The grade of regurgitation was not suffi cient to infl uence the clinical course.