Seeing The Change: How CT Enhances Planning And Prediction In Alcohol Septal Ablation

Document Type

Conference Proceeding

Publication Date

7-1-2025

Publication Title

J Cardiovasc Comput Tomogr

Abstract

Introduction: Transcatheter mitral valve implantation is a minimally invasive option for treating mitral valve disease but is limited by the risk of left ventricular outflow tract (LVOT) obstruction, a high-morbidity and high-mortality event. Preprocedural alcohol septal ablation may reduce LVOT obstruction risk, but the myocardial remodeling process is not fully understood. Cardiac computed tomography (CCT) can be utilized to better understand this process. Methods: 10 patients who underwent preemptive alcohol septal ablation for LVOT obstruction risk were evaluated. Baseline and follow-up CCT studies were evaluated. Basal septal dimension, left ventricular (LV) diastolic dimension, and LV volumes were measured using 3D workstations in diastolic and systolic phases. LVOT prediction was performed using a computer aided design virtual valve implantation Boolean subtraction technique. Results: 7 patients were female (70%). Time between ablation and follow-up CCT scan was 38.6±21.6 days. Average volume of intracoronary alcohol administered was 2.0±0.7 mL. Average pre-ETOH septal ablation diastolic septal thickness was 13.3±2.2 mm and post ablation was 10.8±2.0 mm (P=0.0046) and pre-/post systolic septal thickness was 15.2±2.4 mm / 12.0±2.6 mm (P =0.0012); reflecting a reduction of 21.2±14.7%. Pre-/post LV diastolic dimension was 47.6±5.7 mm compared to 50.8±5.0 mm (P=0.0003). Pre-/post LV systolic dimension was 39.0±6.7 mm compared to 44.3±5.4 mm (P=0.003). Pre-/post LV diastolic volume 128.3±20.4 mL compared to 122.1±24.5 mL (P=0.12). Pre-/post LV systolic volume 44.1±18.6 mL compared to 44.7±19.4 mL (P=0.47). Pre-/post predicted LVOT was 109.2±78.4 mm2 compared to 164.6±98.7 mm2 (P=0.047). Conclusions: CCT provides insight into the myocardial remodeling process after alcohol septal ablation and shows a significant decrease in septal thickness and increase in LV linear dimensions. Lack of statistically significant differences in LV volumes are likely related to low sample size and small relative volumes of ablated tissue compared to overall ventricular volumes. Quantification of changes in septal thickness and LV dimensions contributes to better understanding of the post ablation remodeling process. Further study may facilitate improved patient selection via predictive modeling techniques for the virtual simulation of septal ablations. [Formula presented]

Volume

19

Issue

4

First Page

S98

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