Structural Heart
Percutaneous Transluminal Septal Myocardial Ablation (PTSMA)
What is septal myocardial ablation?
In some people with hypertrophic cardiomyopathy, the muscle wall between the two pumping chambers of the heart (the septum) becomes too thick. This thickened muscle can partly block the way out of the heart, so blood struggles to leave with each beat. Percutaneous transluminal septal myocardial ablation (PTSMA), also called alcohol septal ablation, is a procedure in which a small amount of pure alcohol is injected into a tiny artery that feeds the thickened area. This causes a small, controlled area of the muscle to die and form scar. Over the following weeks to months the wall becomes thinner, so that blood can flow out of the heart more freely.
Why is it done?
It is done for patients whose thickened septum blocks blood flow and causes symptoms such as shortness of breath, chest pain, dizziness or fainting, despite medication. It is an alternative to open-heart surgery (septal myectomy) and is often chosen for patients who prefer to avoid surgery or for whom surgery carries a higher risk.
What happens on the day?
The procedure is done in the catheterisation laboratory under general anaesthetic. Thin tubes are placed in the artery and vein at the groin or wrist. The cardiologist identifies the small branch artery that supplies the thickened muscle with the help of an echocardiogram that is placed in the gullet and contrast that is injected in a vein. A tiny balloon is inflated in the branch artery and a small amount of alcohol is slowly injected.
What to expect afterwards
You are monitored closely in a high-care or coronary care unit for a day or two, with continuous heart rhythm monitoring. Improvement in symptoms often begins soon, but the full benefit can take up to three months as the muscle develops scar and thins. A follow-up echocardiogram is done to check the result.
Possible complications
Most patients do well, but there are risks. The most common is damage to the heart's electrical system, which slows the heartbeat; in roughly one in ten patients this is permanent and a pacemaker is needed. Other possible complications include bruising or bleeding at the puncture site, irregular heart rhythms, a heart attack or a hole developing in the heart muscle.
This information does not replace a consultation. Please discuss your own risks and options with your cardiologist.