Alcohol septal ablation (ASA) is an option in the treatment of obstructive hypertrophic cardiomyopathy refractory to medical therapy.1–3 Cardiac computed tomography (CT) is useful in the selection of patients, as it can simultaneously assess the coronary anatomy and its spatial relations with the myocardium, which is essential in determining the feasibility of ASA and selecting the appropriate septal artery. It can also evaluate the success of the procedure, by assessing the obstruction decreasing and the extent of fibrotic tissue (without additional contrast if performed immediately following ASA), at low dose radiation exposure.1–3

The authors present images illustrating the value of CT, comparing it with the other imaging modalities normally used in this context.

Figure 1 compares images of left ventricular outflow tract (LVOT) obstruction by echocardiography (A) and CT (B), the latter also identifying a septal artery (arrow).

Figure 1.

(A): Two-dimensional transthoracic echocardiogram in parasternal long-axis view in diastole; (B): the same view by multiplanar reconstruction (MPR) cardiac CT, 12 mm thickness, in diastole.

Figure 2 shows the anatomy of the septal arteries by invasive coronary angiography (A) and CT (B–D), showing the relationship between the septal arteries (arrow) and the ventricular chamber (C) and the hypertrophied myocardium (B and D).

Figure 2.

(A): Invasive coronary angiography in right anterior oblique view; (B): maximum intensity projection (MIP) CT coronary angiography, 12 mm thickness; (C) and (D): CT coronary angiography, three-dimensional reconstruction.

Images of the LVOT (Figure 3) by echocardiography (A) and CT (B) following ASA confirm the success of the procedure.

Figure 3.

(A): Two-dimensional transthoracic echocardiogram in parasternal long-axis view in systole; (B): cardiac CT (MPR), 12 mm thickness, 3-chamber view, in systole (25% of the cardiac cycle).

Figure 4 compares late enhancement images by magnetic resonance imaging (A) and CT (B) following ASA, showing areas of myocardial fibrosis (arrows) and microvascular lesion induced by alcohol ablation (triangle).

Figure 4.

(A): Cardiac magnetic resonance (phase-sensitive inversion recovery), late enhancement study in short-axis view; (B): cardiac CT (MPR), 12 mm thickness, in the same view.

Cardiac CT is a non-invasive technique that can be used to plan ASA, assess the outcome and predict its long-term success.