Transcoronary Ablation Of Septal Hypertrophy (TASH)

Hypertrophic cardiomyopathy is a complex cardiac disease associated with diverse clinical, morphologic, and pathophysiologic manifestations. However, one of the most characteristic abnormalities is a hypertrophied and nondilated left ventricle, which may impair diastolic filling. When the hypertrophy results in left ventricular outflow obstruction, dyspnea, angina, syncope, or the development of congestive heart failure may occur. Pharmacologic therapies include beta-blockers or calcium-channel blockers to decrease the heart rate with a consequent prolongation in diastole and increased passive ventricular filling. If medical therapy is insufficient to control symptoms, strategies to reduce the outflow obstruction may be considered. Surgical reaction focuses on removing a small amount of myocardium at the base of the septum (myotomy-myomectomy). Dual-chamber pacing has also been explored as a means of decreasing the pressure gradient in the outflow tract, although results of randomized trials have been disappointing. Transcoronary ablation of septal hypertrophy (TASH) has been explored as an alternative to open surgical septal resection. The technique involves infusion of ethanol through an angioplasty catheter threaded into the septal perforator branches of the left anterior descending artery to infarct and subsequently thin the bulging septum. A key component of the procedure is the identification of the target vessels. A balloon catheter is introduced into the septal branches. The balloon is inflated and contrast injected into the balloon lumen to delineate the area supplied by the septal branch and to ensure that the balloon inflation would prevent spillage of the subsequent injection of alcohol into the left anterior descending artery. Myocardial contrast echocardiography has also been used to target septal vessels. Echocardiographic contrast material may be injected into the balloon catheter and, using ultrasonography, the perfused area of the myocardium can be imaged from several different positions. TASH may also be referred to as ethanol septal ablation. <a id="