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Alcohol therapy for rare heart ailment

Not a scalpel, but 4 ml of absolute alcohol was used for the first time in eastern India to cure a case of obstructive cardiomyopathy — a rare heart condition where the ventricle walls become enlarged, obstructing blood flow in the heart, leading to sudden death if untreated.

Little exertion would leave 60-year-old Amalesh Roy short of breath. He was suffering occasional fainting spells as well. The advice of cardiologists was to have a pacemaker implant or corrective surgery.

Then, a cardiologist at Command Hospital examined Roy, referring him to interventional cardiologist Tarun Praharaj of B.M. Birla Heart Research Centre, who carried out a series of tests, including a 2D echocardiography and Doppler examination.

The tests confirmed he was suffering from a rare disease known as “hypertrophic obstructive cardiomyopathy”. This is an ailment where the heart muscles, generally of the left ventricle — the main pumping chamber of the heart — and also of the right ventricle, are thickened, while the septum — the wall between the two ventricles — becomes enlarged. This obstructs the blood flow from the left ventricle to the aorta. “The tests only confirmed that Roy had been suffering from cardiomyopathy,” said Harminder Singh of Command Hospital.

The symptoms of cardiomyopathy generally take time to surface. “Unfortunately, the first clinical manifestation in many cases turns out to be sudden death,” Praharaj added. Unsuspected hypertensive cardiomyopathy is an abnormality commonly found during autopsy of young athletes or those in their late thirties or early forties.

Doctors had considered implanting Roy with a dual chamber pacemaker. “Instead, we opted for a treatment that had never been attempted here — Alcohol Septal Ablation. It involves injecting pure alcohol into the affected areas, clearing the thickened ventricles,” explained Praharaj.

Specialist Samin Sharma, director of the cardiac cath laboratory at Mount Sinai Hospital in New York, was in town at the time and met with Praharaj and Singh to give them tips on how to perform the procedure. A workshop was also organised last week for city doctors.

The maiden attempt was a success. “The absolute alcohol was injected slowly into the septal perforator artery, which cleared the obstruction in the left ventricle. This is a far less invasive procedure than conventional surgery and has a proven track record in other nations,” Praharaj added. After two days of rest, Roy left for his Barrackpore home and is reportedly recuperating without any complications.

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