PTSMA

Percutaneous transluminal septal myocardial ablation
A procedure in which the septal branch of the ACS ( Arteria coronaria sinistra ) is closed (embolized) by alcohol.

It is performed using a catheter inserted, similar to PCI, by radial or femoral approach (more preferred in PTSMA).

The alcohol balloon is inserted through the ACS into the septal branch. When the balloon inflates, the corresponding alcoholic solution is released. The flow is stopped - it is artificially embolized. Then the guide wire is pulled out.

Indication

 * Hypertrophic cardiomyopathy - when other treatments fail and the symptoms are more severe, the patient may drop out during exercise.

Complications

 * 1) Line failure may occur - AV. Block -  Pacemaker implantation required because the septum atrophies during embolization and may damage the AV node.
 * 2) Myocardial infarction - if alcohol enters another  coronary artery eg RIA ( Ramus interventricularis anterior ) causes closure.
 * 3) Cardiac arrest - especially in elderly patients.

Prognosis
After a successful procedure, we can expect septal atrophy, which can be reflected on the ECG image of septal STEMI - in this case it is physiological !! Beware of the STEMI anterior, it signals a complication, ie a possible embolization of another branch of the ACS.

However, the septum does not have to atrophy, it remains hypertrophic - then we proceed to septal myectomy.

Related Articles

 * Electrocardiography