{"status":"ok","message-type":"work","message-version":"1.0.0","message":{"indexed":{"date-parts":[[2025,9,11]],"date-time":"2025-09-11T20:44:00Z","timestamp":1757623440572,"version":"3.44.0"},"reference-count":21,"publisher":"Frontiers Media SA","license":[{"start":{"date-parts":[[2025,9,9]],"date-time":"2025-09-09T00:00:00Z","timestamp":1757376000000},"content-version":"vor","delay-in-days":0,"URL":"https:\/\/creativecommons.org\/licenses\/by\/4.0\/"}],"content-domain":{"domain":["frontiersin.org"],"crossmark-restriction":true},"short-container-title":["Front. Cardiovasc. Med."],"abstract":"<jats:sec><jats:title>Purpose<\/jats:title><jats:p>Myocardial contrast echocardiography in alcohol septal ablation (ASA) is critical prior to alcohol injection into the target septal artery branch. However, current contrast agents are expensive, carry the risk of anaphylaxis reaction, and are widely unavailable. Against this background, in this study, we introduce a practical solution for the assessment of target septal arteries by using physiological, practical, and safer intracoronary injections.<\/jats:p><\/jats:sec><jats:sec><jats:title>Methods<\/jats:title><jats:p>This study included 14 patients (8 females, 6 males), with symptomatic hypertrophic obstructive cardiomyopathy who underwent ASA between the years 2017 and 2025. Because of the unavailability and the high cost of contrast agents in our country, we used practical physiological agents, which comprised a cocktail fluid (agitated 5\u2005mL of saline plus 0.5\u2005mL blood of the patient). We injected ethanol (absolute alcohol 96%\u201399%) into the target perforatory artery using transesophageal echocardiography (TEE) in a step-by-step manner to observe a reduction in mitral regurgitation and QT prolongation at electrocardiographic monitorization (initially, 0.5\u2005mL alcohol, then by increasing the dosage up to 3\u2005mL).<\/jats:p><\/jats:sec><jats:sec><jats:title>Results<\/jats:title><jats:p>We clearly obtained a good myocardial opacification of the interventricular basal septum border with our cocktail contrast agent. Furthermore, we used TEE in the ASA procedure, unlike other researchers who reported on this procedure. No arrhythmias and allergic reactions were recorded during the administration of the contrast agent. The mean dose of alcohol administered during ASA was 2.1\u2009\u00b1\u20090.7\u2005mL. The procedural rate of success was highest (100%). We assessed the effectiveness of the treatment in terms of a reduction of the peak left ventricular outflow tract gradient and the disappearance of severe mitral regurgitation with a significantly systolic anterior motion.<\/jats:p><\/jats:sec><jats:sec><jats:title>Conclusions<\/jats:title><jats:p>The use of a physiological cocktail fluid in TEE exemplifies the use of a practical, alternative myocardial contrast agent for alcohol septal ablation.<\/jats:p><\/jats:sec>","DOI":"10.3389\/fcvm.2025.1634818","type":"journal-article","created":{"date-parts":[[2025,9,9]],"date-time":"2025-09-09T06:02:47Z","timestamp":1757397767000},"update-policy":"https:\/\/doi.org\/10.3389\/crossmark-policy","source":"Crossref","is-referenced-by-count":0,"title":["Contrast echocardiography with a physiological contrast agent for alcohol septal ablation"],"prefix":"10.3389","volume":"12","author":[{"given":"Erdogan","family":"Ilkay","sequence":"first","affiliation":[],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Yasemin","family":"Saglam","sequence":"additional","affiliation":[],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Ersin","family":"Saricam","sequence":"additional","affiliation":[],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Bilge Duran","family":"Karaduman","sequence":"additional","affiliation":[],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Fehmi","family":"Kacmaz","sequence":"additional","affiliation":[],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Aysel","family":"Yakici","sequence":"additional","affiliation":[],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Cigdem","family":"Koca","sequence":"additional","affiliation":[],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Melike","family":"Polat","sequence":"additional","affiliation":[],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Zeynep Seyma","family":"Turinay","sequence":"additional","affiliation":[],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Mehmet Akif","family":"Erdol","sequence":"additional","affiliation":[],"role":[{"role":"author","vocabulary":"crossref"}]}],"member":"1965","published-online":{"date-parts":[[2025,9,9]]},"reference":[{"key":"B1","doi-asserted-by":"publisher","first-page":"3503","DOI":"10.1093\/eurheartj\/ehad194","article-title":"2023 ESC guidelines for the management of cardiomyopathies","volume":"44","author":"Arbelo","year":"2023","journal-title":"Eur Heart J"},{"key":"B2","doi-asserted-by":"publisher","first-page":"e1239","DOI":"10.1161\/CIR.0000000000001250","article-title":"2024 AHA\/ACC\/AMSSM\/HRS\/PACES\/SCMR guideline for the management of hypertrophic cardiomyopathy: a report of the American Heart Association\/American College of Cardiology joint committee on clinical practice guidelines","volume":"149","author":"Ommen","year":"2024","journal-title":"Circulation"},{"key":"B3","doi-asserted-by":"publisher","first-page":"228","DOI":"10.1002\/ejhf.1715","article-title":"Hypertrophic cardiomyopathy: the future of treatment","volume":"22","author":"Tuohy","year":"2020","journal-title":"Eur J Heart Fail"},{"key":"B4","doi-asserted-by":"publisher","first-page":"912","DOI":"10.1016\/j.cjca.2014.04.008","article-title":"Angiographic and echocardiographic correlates of suitable septal perforators for alcohol septal ablation in hypertrophic obstructive cardiomyopathy","volume":"30","author":"Chan","year":"2014","journal-title":"Can J Cardiol"},{"key":"B5","doi-asserted-by":"publisher","first-page":"1134","DOI":"10.1016\/j.jcin.2017.03.030","article-title":"Outcomes of alcohol septal ablation in younger patients with obstructive hypertrophic cardiomyopathy","volume":"10","author":"Liebregts","year":"2017","journal-title":"JACC Cardiovasc Interv"},{"key":"B6","first-page":"336","article-title":"The \u201c1st septal unit\u201d in hypertrophic obstructive cardiomyopathy: a newly recognized anatomo-functional entity, identified during recent alcohol septal ablation experience","volume":"34","author":"Angelini","year":"2007","journal-title":"Tex Heart Inst J"},{"key":"B7","doi-asserted-by":"publisher","first-page":"219","DOI":"10.1007\/s00059-013-3794-2","article-title":"Serial septal branch assessment in hypertrophic obstructive cardiomyopathy: new echocardiographic contrast agent for alcohol septal ablation","volume":"39","author":"Rigopoulos","year":"2014","journal-title":"Herz"},{"key":"B8","doi-asserted-by":"publisher","first-page":"1570","DOI":"10.1002\/ehf2.14272","article-title":"Alcohol septal ablation in hypertrophic cardiomyopathy: for which patients?","volume":"10","author":"Achim","year":"2023","journal-title":"ESC Heart Fail"},{"key":"B9","doi-asserted-by":"publisher","first-page":"295","DOI":"10.1056\/NEJMoa021332","article-title":"Effect of left ventricular outflow tract obstruction on clinical outcome in hypertrophic cardiomyopathy","volume":"348","author":"Maron","year":"2003","journal-title":"N Engl J Med"},{"key":"B10","doi-asserted-by":"publisher","first-page":"489","DOI":"10.1016\/j.jacc.2017.06.011","article-title":"Alcohol septal ablation for obstructive hypertrophic cardio myopathy: a word of balance","volume":"70","author":"Sorajja","year":"2017","journal-title":"J Am Coll Cardiol"},{"key":"B11","doi-asserted-by":"publisher","first-page":"95","DOI":"10.1016\/j.ccl.2018.08.006","article-title":"Surgical myectomy: subaortic, midventricular, and apical","volume":"37","author":"Nguyen","year":"2019","journal-title":"Cardiol Clin"},{"key":"B12","doi-asserted-by":"publisher","first-page":"2096","DOI":"10.1016\/j.jtcvs.2017.10.054","article-title":"Combined transaortic and transapical approach to septal myectomy in patients with complex hypertrophic cardio myopathy","volume":"155","author":"Hang","year":"2018","journal-title":"J Thorac Cardiovasc Surg"},{"key":"B13","doi-asserted-by":"publisher","first-page":"582","DOI":"10.1093\/ejcts\/ezx398","article-title":"Does septal thickness influence outcome of myectomy for hypertrophic obstructive cardiomyopathy?","volume":"53","author":"Nguyen","year":"2018","journal-title":"Eur J Cardiothorac Surg"},{"key":"B14","doi-asserted-by":"publisher","first-page":"353","DOI":"10.21037\/acs.2017.07.07","article-title":"Results of surgical septal myectomy for obstructive hypertrophic cardiomyopathy: the Tufts experience","volume":"6","author":"Rastegar","year":"2017","journal-title":"Ann Cardio Thorac Surg"},{"key":"B15","doi-asserted-by":"publisher","first-page":"1527","DOI":"10.1016\/j.athoracsur.2008.01.061","article-title":"Mitral valve abnormalities in hyper trophic cardiomyopathy: echocardiographic features and surgical outcomes","volume":"85","author":"Kaple","year":"2008","journal-title":"Ann Thorac Surg"},{"key":"B16","doi-asserted-by":"publisher","first-page":"1677","DOI":"10.1016\/j.amjcard.2013.01.340","article-title":"Papillary muscle insertion directly into the anterior mitral leaflet in hypertrophic cardiomyopathy, its identification and cause of outflow obstruction by cardiac magnetic resonance imaging, and its surgical management","volume":"111","author":"Rowin","year":"2013","journal-title":"Am J Cardiol"},{"key":"B17","doi-asserted-by":"publisher","first-page":"285","DOI":"10.2174\/1573403(11666150107160344","article-title":"Twenty years of alcohol septal ablation in hypertrophic obstructive cardiomyopathy","volume":"12","author":"Rigopoulos","year":"2016","journal-title":"Curr Cardiol Rev"},{"key":"B18","first-page":"461","article-title":"Alcohol septal ablation for hypertrophic obstructive cardiomyopathy","volume-title":"Percutaneous Interventional Cardiovascular Medicine, the PCR-EAPCI Textbook","author":"Seggewiss","year":"2012"},{"key":"B19","doi-asserted-by":"publisher","first-page":"2093","DOI":"10.1055\/s-0032-1305229","article-title":"Myocardial contrast echocardiography guided alcohol septal ablation in hypertrophic obstructive cardiomyopathy with a new echocardiographic contrast agent","volume":"137","author":"Pfeiffer","year":"2012","journal-title":"Dtsch Med Wochenschr"},{"key":"B20","doi-asserted-by":"publisher","first-page":"347","DOI":"10.1016\/j.euje.2004.01.001","article-title":"Echo-guided percutaneous septal ablation for symptomatic hypertrophic obstructive cardiomyopathy: 7 years of experience","volume":"5","author":"Faber","year":"2004","journal-title":"Eur J Echocardiogr"},{"key":"B21","doi-asserted-by":"publisher","first-page":"S51","DOI":"10.1016\/j.ihj.2015.11.020","article-title":"Gelatin lights-agitated gelatin as an echocardiographic contrast agent for alcohol septal ablation","volume":"68","author":"Bahl","year":"2016","journal-title":"Indian Heart J"}],"container-title":["Frontiers in Cardiovascular Medicine"],"original-title":[],"link":[{"URL":"https:\/\/www.frontiersin.org\/articles\/10.3389\/fcvm.2025.1634818\/full","content-type":"unspecified","content-version":"vor","intended-application":"similarity-checking"}],"deposited":{"date-parts":[[2025,9,9]],"date-time":"2025-09-09T06:02:49Z","timestamp":1757397769000},"score":1,"resource":{"primary":{"URL":"https:\/\/www.frontiersin.org\/articles\/10.3389\/fcvm.2025.1634818\/full"}},"subtitle":[],"short-title":[],"issued":{"date-parts":[[2025,9,9]]},"references-count":21,"alternative-id":["10.3389\/fcvm.2025.1634818"],"URL":"https:\/\/doi.org\/10.3389\/fcvm.2025.1634818","relation":{},"ISSN":["2297-055X"],"issn-type":[{"value":"2297-055X","type":"electronic"}],"subject":[],"published":{"date-parts":[[2025,9,9]]},"article-number":"1634818"}}