Introduction: Hypertrophic cardiomyopathy (HOCM) is a genetic disease characterized by left ventricular hypertrophy that has variable morphologic and hemodynamic manifestations. Alcohol septal ablation (ASA) has emerged as a widely accepted alternative to surgical myomectomy for the management of HOCM. In this percutaneous, procedure, pure ethanol is injected into the septal perforator Septal perforator of left anterior descending that supplies the hypertrophied myocardium, leading to infarction and thinning of the myocardium thinning of the hypertrophied.
Case Report: A 62-year-old female with known history of HOCM presented with progressive dyspnea, dizziness and intermittent chest pain, despite high doses of beta-blocker and calcium channel blocker calcium channel blockers. Echocardiography revealed asymmetric septal hypertrophy with septal thickness of 16–19 mm, systolic anterior motion of the anterior mitral leaflet and a resting LVOT gradient of 35–40 mmHg, which increased to 124 mmHg with Valsalva. Non-selective angiogram revealed an anomalous septal artery arising from a separate ostium in the right coronary sinus (Bonapace artery). Bonapace artery fed the hypertrophic basal septum and was a suitable target for alcohol septal ablation.
Conclusion: In this report, we describe a rare case of clinically important Bonapace artery in the absence of coronary artery disease. Additionally, this artery was utilized to perform successful ASA to achieve gradient reduction and relief of symptoms in HOCM. The presence and clinical importance of an anomalous septal artery should be sought in HOCM patients with lack of dominant septal artery from the left coronary system.

Keywords: Aberrant septal artery, Alcohol septal ablation, Hypertrophic cardiomyopathy