Angiography during septal ablation for HCM

Alcohol septal ablation in a patient with hypertrophic cardiomyopathy (HCM). Right anterior oblique cranial coronary angiography shows (top left) baseline appearance of the first septal perforator (arrow; not shown in this still image but seen on cine was clear "milking" of this septal branch during systole owing to the compression of septal contraction), (bottom left) inflation of angioplasty balloon in that branch, (bottom right) contrast injection via balloon central lumen, and (top right) final result with obliteration of septal perforator without compromise or embolization of the left anterior descending artery.