PTSMA

Percutaneous transluminal septal myocardial ablation
It is a procedure in which the septal branch of the ACS (arteria coronaria sinistra, left coronary artery) is closed (embolized) using alcohol.

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

The alcohol-containing balloon is inserted through the ACS into the septal branch. When the balloon inflates, the alcohol solution is released. This leads to the stopping of blood flow: the artery is artificially embolized. Afterward, the guide wire is pulled out.

Indication

 * Hypertrophic cardiomyopathy: The procedure is performed when other treatments fail and the symptoms are more severe.

Complications

 * 1) Cardiac conduction system failure may occur: AV Block - the septum atrophies during embolization and may damage the AV node. Pacemaker implantation is required to treat this.
 * 2) Myocardial infarction can occur if the alcohol enters another coronary artery such as the RIA (ramus interventricularis anterior), leading to its embolization.
 * 3) Cardiac arrest - especially in elderly patients.

Prognosis
After a successful procedure, we can expect septal atrophy, which can be observed using ECG (septal STEMI, in this case it is to be expected!!). Beware of an anterior STEMI, which indicates a possible complication (i.e., a possible embolization of another branch of the ACS).

In some cases, the septum does not undergo atrophy, remaining hypertrophic. In such cases, a septal myectomy is performed.

Related Articles

 * Electrocardiography
 * Cardiac conduction system