Is the heart muscle thickening? Let's talk about Alcohol Septal Ablation (ASA) treatment!

Do you sometimes feel short of breath, a tightness in your chest, or just tired when you're a little tired? There can be many reasons for these symptoms. But sometimes the cause is a problem with the heart. Today we're talking about a special treatment for such heart conditions that doesn't require major surgery.

Simply put, what is Alcohol Septal Ablation (ASA)?

This name may sound a bit complicated, but let's keep it simple. Alcohol Septal Ablation (ASA) is a minimally invasive treatment performed by cardiologists.

This treatment is for people with a heart condition called Hypertrophic Cardiomyopathy (HCM) . The name is a bit confusing, isn't it? Simply put, this disease causes the heart muscle to thicken excessively. More specifically, the wall that separates the two chambers of the heart, called the septum , becomes thicker.

Imagine your heart is a water pump. This pump is what sends blood to the whole body. Now, if the wall of this pump becomes too thick, the space for blood to flow out becomes narrow, right? That's what happens in HCM. When the wall of the heart thickens, blood doesn't pump out properly. This is why the symptoms we mentioned earlier, such as shortness of breath and fatigue, occur.

So, in this ASA treatment, a very thin, flexible tube (catheter) is used to find the blood vessel that supplies blood to that thickened muscle part of the heart. Then, a little special alcohol is injected through that tube into that thickened muscle part. This alcohol causes the cells that have grown unnecessarily to die, and that part shrinks and shrinks. Then the path for blood to flow out of the heart becomes wider again, and blood flow is restored.

Who is this treatment best suited for?

This treatment is for people with the condition we mentioned earlier called Hypertrophic Cardiomyopathy (HCM). This is an inherited disease. This means that if someone in your family has it, you have a chance of developing it too.

Usually, people with HCM are first given medications. However, for some people, even with medications, the symptoms (such as shortness of breath and fatigue) are not controlled. That's why doctors consider ASA treatment for these people.

There is another option for this. That is an open-heart surgery called Septal Myectomy . In this, the chest is opened and the thickened muscle is cut out and removed. However, since it is a major surgery, it takes longer to heal and the risks are higher.

Simply put, this is a successful alternative treatment for those who cannot undergo major surgery.

How do you prepare before treatment?

Once your doctor has decided that this treatment is right for you, there are a few things you need to do beforehand. Your doctor will give you clear instructions on this.

What happens during treatment?

This treatment is performed in a special room (Cath Lab) in the hospital's cardiology unit. It usually takes about an hour or two.

• You have consciousness:In this, you are not completely anesthetized. This means you are conscious. But you are given sedatives to keep you relaxed and fearless.
• Needle anesthesia: A needle is used to numb the area where the catheter is inserted, such as near your wrist or groin.
• Inserting the catheter: The doctor then passes the thin tube through a blood vessel from the numb area to the heart.
• X-ray monitoring: Doctors use X-ray images to check the path of the tube and whether it is going to the correct place in the heart.
• Alcohol injection: Once the correct blood vessel is found, a small amount of a special alcohol called isopropyl alcohol is injected through the tube into the thickened muscle. You may feel some discomfort or pain in your chest at this time. This is normal.
• A temporary pacemaker: During treatment, a wire from a temporary pacemaker is inserted into a vein in your neck. This is left in place for two to three days after treatment to monitor your heart rhythm.
• End: When the work is finished, the tube is removed and the area is closed with stitches or a tight compression bandage.

What happens after treatment?

After treatment, you will need to stay in the hospital for two or three days (48-72 hours). This time is very important.

• Heart rate monitoring: During these days, the medical team will continue to monitor your heart rhythm. This is because, as a minor side effect of this treatment, some people may experience an effect on the electrical signals in their heart. This is called Heart Block . If this happens, your heart rate may become too slow . That is why you will be closely monitored.
• Bed rest: If the tube was inserted through your groin, you will be asked to stay in bed with your legs straight for a few hours to prevent bleeding. If it was inserted through your wrist, you usually don't need to stay that way.
• Painkillers: You will be given painkillers if needed.
• Re-examination: Before leaving the hospital, you may have another test, such as an echocardiogram , to see how successful the treatment is.

What are the benefits and risks of this treatment?

As with any medical treatment, there are benefits as well as some minor risks.

What are the advantages?

The main advantage is that it does not require open-heart surgery. Therefore:

• The recovery time is very short.
• Complications associated with surgery are few.
• It won't leave a big scar.
• This is the best option for those who cannot afford major surgery.

What are the risks?

Complications are rare, but it's important to be aware of them. Your doctor will tell you more about this.

How long does it take to heal?

This varies from person to person. Your recovery time will depend on your general health. Most people can return to normal activities within a week or so . However, you should always check with your doctor before starting anything like strenuous exercise.

Many people begin to feel significant relief from their symptoms immediately after treatment.

If you have these symptoms, see a doctor immediately!

If you experience any of the following symptoms after returning home from treatment, call your doctor immediately or go to the nearest hospital's Emergency Department (ETU).

• An abnormal heartbeat or feeling like your chest is pounding (palpitations).
• Chest pain.
• Difficulty breathing, rapid breathing (dyspnea) .
• Dizziness or blue eyes.
• Very tired.
• Redness, swelling, bleeding, or fever where the tube was inserted (these are signs of infection).
• Nausea and vomiting.

Alcohol Septal Ablation is a very effective treatment for Hypertrophic Cardiomyopathy. It can control symptoms with less risk and a quicker recovery than surgery. If you have any questions about this, don't hesitate to talk to your cardiologist for more information.