70岁以上肥厚性梗阻型心肌病患者化学消融的安全性初探

目的:总结70岁以上肥厚性梗阻型心肌病(HOCM)患者行经皮室间隔心肌化学消融术(PTSMA)治疗的并发症发生情况及近期疗效,探讨70岁以上HOCM患者行PTSMA的利与弊。方法:对1998-07至2010-07我院行PTSMA治疗的9例70岁以上HOCM患者的临床资料和化学消融结果进行回顾性分析,总结其化学消融术中和术后围术期并发症的发生情况及近期疗效。结果:9例70岁以上HOCM患者中共8例接受PTSMA治疗,术后静息及早搏后左心室流出道压力阶差明显降低(13.29±16.60 vs 77.71±45.51,P=0.006;42.25±21.98 vs 113.50±38.46,P=0.04),左心室射血分数较术前略有下降,但差异无统计学意义(0.60±0.05 vs 0.62±0.05,P=0.053)。术中发生完全性右束支传导阻滞3例,Ⅲ度房室传导阻滞1例,急性心包填塞、死亡1例,急性左心衰竭、死亡1例。结论:70岁以上HOCM患者行PTSMA治疗是有效的,但围术期并发症发生率较高,死亡率较高,因此70岁以上HOCM患者行PTSMA弊大于利,应谨慎施行。

Safety Investigation of Percutanous Transluminal Septal Myocardial Ablation in Aged Patients With Hypertrophic Obstructive Cardiomyopathy

Objective:To investigate the safety and complication of percutanous transluminal septal myocardial ablation(PTSMA)in aged patients with hypertrophic obstructive cardiomyopathy(HOCM). Methods:A total of 9 HOCM patients treated by PTSMA in our hospital from 1998 to 2010 were retrospectively studied.The clinical informations,effects and complications of PTSMA during the procedure and at the peri-operative period were summarized. Results:There were 8/9 patients received PTSMA.The left ventricular outflow tract pressure gradient at quiet condition and post premature beat were significantly dropped after the operation(13.29±16.60 vs.77.71±45.51,P=0.006)and(42.25±21.98 vs.113.50±38.46,P=0.04).Left ventricular ejection fraction decreased at certain point,P>0.05.There were 3 patients combined with right bundle branch block,1 with complete atrioventricular block and 2 died during the operation. Conclusion:PTSMA was an effective treatment for aged HOCM patients,while the complication rate and the mortality were relatively high.