Inferior infarction following alcohol septal ablation: A consequence of “collateral damage”?

Alcohol septal ablation is fast becoming the most common method to reduce left ventricular outflow tract gradient in patients with symptomatic hypertrophic obstructive cardiomyopathy. Myocardial contrast echocardiography (MCE) is routinely used as an adjunct to avoid the spread of alcohol to non‐target areas of myocardium. We report two cases where despite the careful use of MCE, remote inferior wall myocardial infarctions occurred. The likely mechanism and possible preventive measures are discussed. © 2006 Wiley‐Liss, Inc.