Use of intraprocedural CT imaging to guide alcohol septal ablation of hypertrophic cardiomyopathy in the cardiac catheterization laboratory.

Alcohol septal ablation (ASA) is a common treatment for hypertrophic cardiomyopathy. The success of the procedure is dependent on targeting a small dose of alcohol to the appropriate septal perforator in order to cause a myocardial infarction in the septum at the point of mitral valve contact. Typically, this is identified by injecting echocardiographic contrast into a septal vessel and using echocardiography to confirm that the area of septal-systolic anterior motion contact is highlighted. Rotational angiography using the C-arm in the catheterization laboratory acquires a 3-dimensional "CT-like" image, and has shown promise in providing anatomic guidance in coronary and structural heart disease interventions. We demonstrate here a novel application of intraprocedural CT imaging to localize the region of interest for ASA in the catheterization laboratory.