肥厚型梗阻性心肌病化学消融术后疗效观察

目的 探讨化学消融治疗肥厚型梗阻性心肌病(HOCM)的方法及疗效.方法 15例HOCM患者,经超声心动图及导管测压证实存在左室流出道压力阶差.选择靶间隔支注入无水乙醇消融后记录左室流出道压力阶差变化,出院时、出院后1个月及出院后3个月复查超声心动图.结果 15例中消融第一间隔支11例,消融第二间隔支2例,同时消融第一、二间隔支2例.1例术后4 h死亡,其余14例度过围术期并出院随访(其中1例术后5 d置入永久双腔起搏器).术后即刻导管测量左室流出道压差较术前明显下降[(55.90±31.08)mm Hg比(92.62±43.75)mm Hg,P＜0.01],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[(45.83±27.92)mm Hg 比(84.02±35.59)mm Hg,(2.3±1.28)mm 比(4.2±1.35)mm,P＜0.01];出院后1个月、3个月超声测量LVOTG、左室流出道内径、室间隔厚度和SAM幅度较术前及出院时明显改善(P＜0.01).结论化学消融是治疗HOCM的有效方法,但属于破坏性手术,需严格进行手术风险控制,防止"过犹不及".

Efficiency of percutaneous transluminal septal myocardial ablation on hypertrophic obstructive cardiomyopathy

Objective To evaluate the feasibility and efficiency of percutaneous transluminal septal myocardial ablation （PTSMA） for treatment of hypertrophic obstructive cardiomyopathy （HOCM）. Methods Fifteen patients with 1-10 years 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 myocardiurn, width of LVOT and amplitude of systolic anterior motion（SAM ） were also measured before, at the time of dis- charge and 1 month and three months after PTSMA by echocardiography. Results fourteen patients were accom- plished by sigwart method, among which, DDD pacemaker was implanted in one patient because of permanent complete heart block 5 days later. One patient died from acute myocardial infarction 4 hours after ablation. Immediate post-operation, LVOTG decreased significantly from （92.62±43.75）mm Hg to （55.90±31.08）mm Hg （P〈 0.01 ）. At the time of discharge, LVOTG and amplitude of SAM improved significantly [ （45.83±27.92）mm Hg vs （84.02±35.59）mm Hg, （2.3±1.28）mm vs （4.2±1.35）mm, P〈0.01]. At 1 month and 3 months follow up, LVOTG, thickness of septal myocardium, width of LVOT and amplitude of SAM had a good direction to improvement（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.