Contrast Echocardiography with Physiological Contrast Agent for Alcohol Septal Ablation

Erdoğan İlkay¹Yasemin Saglam²Ersin SARICAM^1*Bilge Duran Karaduman³Fehmi Kaçmaz³Aysel Yakici⁴Cigdem Koca⁵Melike Polat¹Zeynep Seyma Turinay¹Mehmet Akif Erdol⁶

• ¹Department of Cardiology, Medicana International Ankara Hospital, Ankara, Turkiye, Ankara, Türkiye
• ²Department of Cardiology, Guven Hospital, Ankara, Turkey, Ankara, Türkiye
• ³Cardiology Clinic, School of Medicine, Üsküdar University, Istanbul, Turkiye, Istanbul, Türkiye
• ⁴Sultangazi Educational and Research Hospital, Istanbul, Turkiye, Istanbul, Türkiye
• ⁵School of Medicine, Yeditepe University, Istanbul, Türkiye, Istanbul, Türkiye
• ⁶Cardiology Clinic, Saglik Bilimleri University, Ankara, Türkiye, Ankara, Türkiye

Purpose: Myocardial contrast echocardiography in alcohol septal ablation is critical prior to alcohol injection for the target septal artery branch. However, current contrast agents are expensive, carry the risk of anaphylaxis reaction and wide unavailability. We have introduced a practical solution for the assessment of target septal arteries by using physiological, practical, and safer intracoronary injections.Methods: This study included 14 patients (8 females, 6 males,) with symptomatic hypertrophic obstructive cardiomyopathy underwent ASA between the years 2017 and 2025. Because of their unavailability in our country and the high cost of the contrast agents, we used practical physiological agents, which is a cocktail fluid (agitated 5mL of saline plus 0.5 mL blood of patient). We gave ethanol (absolute alcohol 96%-99%) into the target perforatory artery via TEE with step-by-step technique to observe improvement of mitral regurgitation and QT prolongation at electrocardiographic monitorization (initially, 0.5 ml alcohol, then by increasing the dosage up to 3 ml).We clearly obtained good myocardial opacification of interventricular basal septum border with our cocktailed contrast agent. Furthermore, we used TEE in ASA procedures, unlike others ASA studies. No arrhythmias and allergic reactions were recorded during the administration of the contrast agent. The mean dose of alcohol administered during ASA was 2.1±0.7mL. The procedural success was very high (100%). We assessed the effectiveness of treatment as reduction of peak left ventricular outflow tract gradient and disappear severe mitral regurgitation with significantly systolic anterior motion. Conclusions: Physiological cocktailed fluid by using TEE is a practical, alternative myocardial contrast agent for alcohol septal ablation.