【摘要】 目的:探讨经皮导管室间隔心肌化学消融术(PTSMA)治疗肥厚型梗阻性心肌病(HOCM)方法及近期疗效。方法:11例HOCM患者,经心脏超声及导管测压证实存在左室流出道压力阶差(LVOTG),选择靶间隔支注入无水乙醇消融后记录LVOTG变化,出院时及出院后1个月复查超声心动图。结果:11例患者中消融第1间隔支者9例,消融第2间隔支者1例,同时消融第1、第2间隔支者1例;术后即刻导管测量LVOTG较术前明显下降[(90.40±41.95)∶(52.90±34.12)mmHg(1 mmHg=0.133 kPa),P<0.01]。11例中1例术后4 h死亡,1例术后第5天置入永久双腔起搏器,其余9例度过围术期并出院随访。10例存活者出院时与术前相比,LVOTG和二尖瓣收缩期前移(SAM)幅度较术前明显改善[(44.56±28.87)∶(82.98±36.46)mmHg,(2.3±1.06)∶(4.1±1.37)mm,P<0.01)];术后1个月超声测量LVOTG、室间隔厚度、左室流出道内径和SAM幅度分别为:(40.43±19.27)mmHg、(18.6.1±1.17)mm、(15.5±1.08)mm和(0.5±0.53)mm,均较术前及出院时明显改善(P<0.01)。结论:PTSMA治疗HOCM有一定疗效,但属于破坏性手术,需严格进行手术风险控制。更多还原

【Abstract】 Objective:To evaluate the feasibility and efficiency of percutaneous transluminal septal myocardial ablation(PTSMA) for treatment of hypertrophic obstructive cardiomyopathy(HOCM).Method:Eleven patients with 1 to 10 year history of HOCM underwent the PTSMA.Left ventricular outflow tract gradient(LVOTG) were measured before and after septal branches occluded by 96%-99% alcohol.The thickness of septal myocardium,width of LVOT and amplitude of systolic anterior motion(SAM) were also measured before,at the time of discharge and 1 month after PTSMA by echocardiography.Result:Ten patients were accomplished by Sigwart method and only one patient died from acute myocardial infartion 4 hours after ablation.In survival cases,one of them was implanted DDD pacemaker because of permanent complete heart block 5 days later.Once the operation finished,LVOTG was immediately decreased from(90.40±41.95) mmHg to(52.90±34.12) mmHg(P<0.01).At the time of discharge,LVOTG and amplitude of SAM were improved significantly([82.98±36.46] vs [44.56±28.87]mmHg;[4.10±1.37] vs [2.30±1.06]mmHg,P<0.01) compared with those before operation.At the end of 1 month of following up,LVOTG,thickness of septal myocardium,width of LVOT and amplitude of SAM were all showed a good improvement respectively(P<0.01).Conclusion:PTSMA can significantly reduce LVOTG and has a satisfactory short-term efficacy in the treatment of HOCM.Risk control must be emphasized during the ablation procedure and further careful evaluation is needed.更多还原