Septal Embolization Using Ethylene Vinyl Alcohol Copolymer in Hypertrophic Obstructive Cardiomyopathy

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BACKGROUND: Hypertrophic obstructive cardiomyopathy (HOCM) is a genetic cardiac disorder characterized by left ventricular outflow tract obstruction due to septal hypertrophy and mitral regurgitation. When medical therapy is insufficient, invasive strategies such as surgical myectomy or percutaneous septal ablation are considered. Alcohol septal ablation is the most common percutaneous option for patients unfit for surgery. However, concerns about the cardiotoxicity of alcohol, the risk of arrhythmias, and pacemaker have prompted exploration of safer alternatives. CASE SUMMARY: We report the case of a 71-year-old woman with symptomatic HOCM who underwent septal embolization using Onyx, a nonalcoholic embolic agent. The patient experienced significant symptomatic and hemodynamic improvement, sustained over 12 months. DISCUSSION: Although alcohol septal ablation remains the standard percutaneous option, Onyx provided targeted septal infarction under fluoroscopic guidance without alcohol-related toxicity. TAKE-HOME MESSAGE: Onyx may be a promising and safe alternative for septal reduction in selected HOCM patients.

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