Early opening of dormant septal collaterals during alcohol septal ablation: a possible hazard of remote necrosis.

Alcohol septal ablation has become a common method to relieve left ventricular outflow track gradient in selected patients with hypertrophic obstructive cardiomyopathy. There is only limited knowledge regarding inadvertent remote (nontarget) myocardial necrosis caused by septal collateral recruitment. Herein we describe a case of unexpected contrast medium leakage through newly opened septal collateral circulation immediately after low-dose ethanol injection suggesting that angiographic inspection of collateral recruitment is necessary in all cases of repeat ethanol injection.