Myectomy or Alcohol Septal Ablation. Surgery and Percutaneous Intervention Go Another Round^**Editorials published in the Journal of the American College of Cardiology reflect the views of the authors and do not necessarily represent the views of JACC or the American College of Cardiology.

Myectomy and alcohol septal ablation are surgical techniques used for the treatment of hypertropic obstructive cardiomyopathy (HOCM). The cardaic magnetic resonance imaging (CMR) investigation performed before and after myectomy and alcohol septal ablation, identified a discrete segment of resection with minimal CMR evidence of myocardial necrosis. A large transmural infraction is found to be located in the basal septum than myectomy and extending into the right ventricular side of the septum at mid-ventricular level. Myectomy is performed through aortotomy and on cardiopulmonary bypass, with resection of septal myocardium to create a channel expanding the left ventricular outflow tract (LVOT). A study of treatment failure with septal ablation found that higher baseline gradient, fewer septal branches injected, lower peak creatine kinase, and smaller risk area by contrast echocardiogram predicted relief of HOCM.