肥厚型心肌病伴心房颤动患者临床特点分析

目的分析32例肥厚型心肌病伴心房颤动患者的临床特点。方法选择1994-2005年在解放军总医院心脏中心就诊的肥厚型心肌病患者158例，平均随访（4．2±2．8）年，按病史、心电图、动态心电图是否记录到心房颤动分为房颤组和非房颤组，观察并比较2组患者的临床特点。结果（1）肥厚型心肌病伴房颤患者共32例，占全部肥厚型心肌病患者的20．3％，其中阵发性房颤14例（43．7％），持续性房颤18例（57．3％），无症状性房颤5例（15．6％）；（2）与非房颤组患者比较，房颤组患者平均年龄偏大（58±10．4vs46±12．6）岁（P〈0．01），左房直径大（42±3．5vs34±5．3）mm（P〈0．01）；（3）房颤组12例（心力衰竭8例，猝死4例）发生心血管事件，非房颤组9例（心力衰竭6例，猝死3例）发生心血管事件。房颤组患者中，房颤引发室颤1例（3％），脑栓塞2例（6．3％），下肢动脉栓塞2例（6．3％）。结论（1）20．3％肥厚型心肌病患者伴心房颤动，其中43．7％为阵发性房颤，57．3％为持续性房颤，15．6％为无症状性房颤；（2）与肥厚型心肌病不伴房颤患者相比，伴房颤患者年龄偏大，心血管事件发生率高。     

经胸超声心动图评价高血压心脏病与左心室流出道梗阻的应用价值

目的:应用经胸超声心动图(transthoracic echocardiography,TTE),评价高血压心脏病与肥厚型心肌病(HCM)左心室流出道梗阻的二维及血流动力学特征,为临床鉴别诊断提供影像学依据。方法:左心室流出道梗阻患者31例,其中高血压性左心室流出道梗阻12例,肥厚型梗阻性心肌病19例,二维图像下测量两组患者的室间隔厚度及左心室后壁厚度,在静息状态和激发试验后测量两组患者的左心室流出道流速及最大压差,分别进行组间及组内比较。结果:室间隔厚度肥厚型心肌病组(19.6±1.8)mm明显高于高血压组(12.4±0.6)mm,差异有统计学意义(P<0.05)。左心室后壁厚度:肥厚型心肌病组(11.5±0.5)mm,高血压组(11.3±0.6)mm,两组间比较差异无统计学意义(P>0.05)。高血压组组内比较激发试验后左心室流出道流速(398.6±36.7)cm/s及压差[(68.4±12.9)mmHg,1 mmHg=0.133kPa],均高于静息状态下流速178.2±23.4)cm/s,压差(13.5±6.2)mmHg,差异有统计学意义(P<0.05)。结论:经胸超声心动图能准确评价左心室流出道梗阻的解剖结构与血流动力学特征,可准确鉴别梗阻类型及梗阻程度。     

经皮腔内室间隔化学消融术治疗肥厚梗阻型心肌病短期疗效

目的应用超声心动图评价经皮腔内室间隔化学消融术(percutaneoustransluminalventricalarseptalchemicalablation,PTVSCA)治疗肥厚型梗阻性心肌病的短期疗效。方法回顾性分析于1998年7月～2003年6月期间40例肥厚型梗阻性心肌病患者行PTVSCA。在消融术前及术后2周内行超声心动图测量室间隔厚度、左心室流出道宽度及左心室流出道压力阶差。结果40例术后两周内室间隔厚度(24±6)mm,术前(24±6)mm;平均左心室流出道宽度术后(12.8±2.6)mm,术前(13.1±2.4)mm;静息时左心室流出道压力阶差术后(101±7)mmHg,术前(40±8)mmHg。结论PTSMA术后即刻或短期内主要是通过降低梗阻部位室间隔的收缩力来缓解左心室流出道的梗阻,室间隔厚度改变需在稍后时间才能显现。     

心肌声学造影引导下梗阻性肥厚型心肌病的化学消融治疗

本文报告 3例梗阻性肥厚型心肌病患者在心肌声学造影技术 (myocardialcontrast echocardiography,MCE)指导下实施化学消融术并取得良好效果。现报告如下 :1　资料与方法　　对象 :2 0 0 0年 3月～ 5月于我院住院的 3例患者 ,男 2例 ,女 1例 ,年龄 33～ 47(平均 42± 6 .3)岁。术前明确诊断为梗阻性肥厚型心肌病。室间隔厚度为17～ 2 4mm,平均 2 0 .6± 2 .8mm。经导管测左心室流出道压力阶差 (L VOTG)4 0～ 80 mm Hg(1mm Hg=0 .133k Pa) ,平均 5 5± 17.8mm Hg。附图　超声心动图图像。箭头所指处为封堵的间隔支血管所支配的心肌确系增…     

经冠状动脉消融肥厚心肌和外科治疗肥厚型梗阻性心肌病

目的　回顾性分析外科和经冠状动脉消融肥厚间隔心肌 (transcoronaryablationofseptalhypertrophy ,TASH)治疗肥厚型梗阻性心肌病 (hypertrophicobstructivecardiomyopathy ,HOCM )近、中期 (3～ 2 4个月 )的疗效和安全性。方法　 54例HOCM患者在我院分别接受外科 (11例 )或TASH(43例 )治疗。治疗前、后评价患者的主观症状和客观检查系列结果。结果　外科和TASH后即刻左室流出道压力阶差 (PGLVOT)下降显著 [外科 (75± 48)mmHg(1mmHg =0 13 3kPa) ,TASH(56± 2 8)mmHg] ,但下降率差异无显著意义 (76 8%比 74 0 % ,P >0 0 5)。6例PGLVOT 反弹 ,TASH后 5例 ,出现在术后 3～ 6个月 ,外科后 1例 ,出现在术后 2 4个月。术后患者主观症状改善显著 ,但改善程度二组患者差别不显著。围术期死亡 2例 ,分别死于脑出血 (外科 )和严重心动过缓 (TASH ,拒绝安装起搏器 )。结论　TASH治疗HOCM的近、中期效果与外科相似 ,与外科相比 ,其并发症也是可以接受的 ,远期效果及安全性还有待观察     

肥厚型梗阻性心肌病的外科治疗

【摘要】目的 评价外科手术治疗肥厚梗阻性心肌病的临床疗效。方法 2010年1月～2013年10月，72例患者因肥厚梗阻性心肌病在我院行外科手术治疗，男36例、女36例，年龄13～70(46.51±13.45)岁。手术在全麻低温体外循环下完成，按常规经主动脉切口行室间隔心肌切除术，同期行冠状动脉旁路移植术4例，二尖瓣置换术8例，二尖瓣成形术2例，主动脉瓣置换术2例，主动脉瓣成形术1例，动脉导管结扎术1例，右室流出道疏通术1例，左房血栓清除1例，左心耳结扎2例，冲洗式射频消融改良迷宫术4例，术中安装永久起搏器2例。围术期心脏超声心动图(UCG)或食道超声心动图(TEE)评价左心室舒张末径、左室流出道流速及压差(LVOT)、室间隔厚度、左室射血分数(EF)、二尖瓣结构和功能。结果 与术前比较，左室流出道压差（9.42±7.48 vs 79.76±51.9）（mmHg） (P<0．01)及室间隔厚度（1.87±0.57 vs 2.36±0.48）（cm）(P<0．01)明显下降，长期随访发现左室流出道压差进一步下降（7.57±5.21）（mmHg），室间隔厚度进一步变薄（1.69±0.45）（cm）。左室舒张末径在出院时有所扩大，长期随访有进一步扩大趋势。EF值较术前有所下降(P<0.01)，但仍在正常范围内。手术死亡0例。主要并发症：完全性左束支传导阻滞52例，右束支传导阻滞2例，室内传导阻滞3例，心房颤动7例（其中3例为阵发性房颤），短暂II～III度房室传导阻滞5例，持续Ⅲ度房室传导阻滞2例，室间隔穿孔1例，术后脑出血2例，急性胆囊炎1例。远期随访：5例失访，余67例术后随访3～53月（平均18个月），所有患者症状消失，生活质量明显改善，心功能I～Ⅱ级，无远期死亡或并发症。结论 肥厚梗阻性心肌病外科手术治疗可有效的减轻左室流出道梗阻，提高患者的生活质量。     

肥厚型梗阻性心肌病经皮经腔间隔心肌消融术与室间隔心肌切除术疗效比较

目的应用超声心动图比较肥厚型梗阻性心肌病患者经皮经腔间隔心肌消融术与室间隔心肌切除术的疗效。方法分别于经皮经腔间隔心肌消融术及室间隔心肌切除术前、后测量肥厚型梗阻性心肌病患者左室流出道压差,比较术前及术后压差。结果肥厚型梗阻性心肌病患者在进行经皮经腔间隔心肌消融术与室间隔心肌切除术后,左室流出道压差均较术前明显减低。经皮经腔间隔心肌消融术肥厚型心肌病患者术前左室流出道压差(99±19)mm Hg(1 mm Hg=0.133 kPa),术后降至(36±20) mm Hg(P<0.05)。进行室间隔心肌切除术肥厚型心肌病患者术前左室流出道压差(117±32) mm Hg,术后降至(28±17) mm Hg(P<0.05)。经皮经腔间隔心肌消融术与室间隔心肌切除术患者术后左室流出道压差差异无统计学意义[(36±20)mm Hg比(28±17)mm Hg]。结论经皮经腔间隔心肌消融术可以明显减低肥厚型梗阻性心肌病患者左室流出道压差,且与室间隔心肌切除术疗效相似。     

经皮室间隔化学消融术对梗阻性肥厚型心肌病二尖瓣反流的影响

目的 评价经皮室间隔化学？肖融术对梗阻性肥厚型心肌病二尖瓣反流的影响。方法选择2007年3月至2012年2月在广东省人民医院诊断为梗阻性肥厚型心肌病的患者41例为研究对象,年龄（51．1±2．2）岁,其中男20例,女21例。利用Sigward法行经皮室间隔化学消融术,浓度99％的无水酒精注入冠状动脉间隔支内,记录术前、术后左心室流出道压力阶差的变化,消融术前及术后第一天通过超声心动图测量左心室流出道压差及二尖瓣反流面积变化。结果导管法术前、术后左心室流出道压力阶差分别为（101．9±33．9）mmHg（1mmHg=0．133kPa）和（54．3±34．7）mmHg,两者比较差异有统计学意义（P〈0．01）。术前、术后二尖瓣反流面积分别为（7．2±2．1）cm。和（4．0±3．0）m2,两者比较差异有统计学意义（P〈0．01）。线性柏关回归分析显示,术前、术后二尖瓣反流面积的变化与左心室流出道压力阶差变化相关（r=0．589,P〈0．01）。结论经皮室间隔化学消融术可以降低梗阻性肥厚型心肌病患者左心室流出道压力阶差,使二尖瓣收缩期前向运动减轻,二尖瓣反流减少：二尖瓣反流的减少可以作为评价经皮冠状动脉室间隔化学消融术疗效的指标之一。     

经食管超声心动图在肥厚型梗阻性心肌病手术中的应用

目的:对比应用经食管超声心动图(TEE)对患者麻醉和手术转归的影响,阐述TEE在肥厚型梗阻性心肌病左心室流出道疏通术中的作用。方法:回顾性调查31例成人肥厚型梗阻性心肌病左心室流出道疏通术患者,分为GTEE和Gn2组,比较手术后2组患者左心室流出道压差、术后转归和并发症。结果:2组的体外循环时间和主动脉阻断时间无差异,GTEE组术后左心室流出道压差[(26±10)mmHg,1mmHg=0.133kPa]明显低于Gn组[(59±28)mmHg,P<0.01];GTEE组术中并发症和术后转归好于Gn组。结论:术中TEE对麻醉监测和手术处理有积极的指导意义。     

扩大室间隔切除治疗肥厚型梗阻性心肌病的临床研究

目的总结扩大室间隔切除治疗肥厚型梗阻性心肌病（HOCM）的临床经验。方法2009年2月至2011年12月我院外科治疗肥厚型梗阻性心肌病42例,其中男性23例,女性19例,年龄13～66（38±6）岁,体重45±85（62．4±14．7）kg。手术在全身麻醉低温体外循环下完成,按常规经主动脉切13行室间隔心肌切除术（改良Morrow技术）,同期完成二尖瓣机械瓣膜置换术2例、冠状动脉旁路移植术5例、主动脉瓣置换术3例。围术期及术后随访心脏超声心动图（UCG）或食管超声心动图（TEE）评价左心房（LA）、左心室（LV）、左室流出道流速及压差（LVOT）、左室射血分数（LVEF）、二尖瓣结构和功能。结果全组患者手术均获得成功,无停机困难,体外循环（84．7±13．8）min,主动脉阻断（60．3±18．4）min。术后所有患者症状均明显改善或消失。超声心动图显示室间隔厚度较术前明显减小,左心室流出道内径较术前明显增宽,左心室流出道压差下降。SAM患者术后超声心动图示SAM消失。二次转机行二尖瓣置换术2例。住院时间11～23d,平均12d。34例获得6～26（14±3）个月随访,随访中进行超声心动图检查。术后10d．6个月及1年的超声心动图均提示LVOTG和室间隔厚度（IVST）较术前显著下降（P〈0．05）;除术前外,其他各时间点的LVOTG和IVST间差异无统计学意义。术后1年心功能（NYHA分级）：I级30例、Ⅱ级3例、Ⅲ级1例。结论扩大室间隔心肌切除术可避免行二尖瓣置换术治疗肥厚型梗阻性心肌病,左心室舒张功能改善,有利于左心室的重塑。患者症状及心功能改善,治疗结果满意。     

Comparison of dual-chamber pacing versus septal myectomy for the treatment of patients with hypertropic obstructive cardiomyopathy: a comparison of objective hemodynamic and exercise end points.

OBJECTIVES: The purpose of this study was to compare the treatment effects of septal myectomy with dual-chamber pacing in patients with hypertrophic obstructive cardiomyopathy (HOCM). BACKGROUND: The optimal treatment for symptomatic patients with drug-refractory HOCM is unknown. Both dual-chamber pacing and surgical myectomy may result in subjective symptom improvement. However, no direct comparisons with objective end points have been reported. METHODS: Thirty-nine patients with symptomatic HOCM were analyzed in this concurrent cohort study. Twenty patients underwent surgical myectomy, and 19 received dual-chamber pacemakers based on patient preference. These patients had prospective baseline and follow-up evaluations including physician assessment, echocardiography and standardized metabolic treadmill exercise testing. RESULTS: Baseline symptom status, left ventricular outflow tract gradients, exercise times and maximal oxygen consumption peak were similar between the two groups. Left ventricular outflow gradient was reduced from 76+/-57 to 9+/-17 mm Hg (p = 0.0001) after myectomy, and from 77+/-61 to 55+/-39 mm Hg (p = 0.07) after pacing (p = 0.02 for comparison with myectomy). Ninety percent of myectomy patients experienced symptomatic improvement as compared with 47% in the pacing group. Exercise duration increased significantly from 6.6+/-2.8 to 8.7+/-3.0 min (p = 0.0003) after myectomy compared with a change from 6.4+/-2.1 to 7.0+/-2.2 min (p = NS) in the pacing group. Maximal oxygen consumption increased from 19.4+/-6.4 to 22.2+/-6.5 ml/kg/min after myectomy (p = 0.004), whereas the pacing group did not experience any significant change (19.6+/-6.5 vs. 20.1+/-6.5 ml/kg/min, p = NS). CONCLUSIONS: Surgical myectomy and dual-chamber pacing improve subjective measures of functional status in patients with symptomatic HOCM. In this nonrandomized study, myectomy offered greater reduction in left ventricular outflow tract gradients and larger improvements in objective measures of patient symptoms and functional status when compared with dual-chamber pacing.     

功能-解剖方法和超声心肌增强方法指导下经冠状动脉消融肥厚心肌治疗肥厚型梗阻性心肌病有效性和安全性的对比研究

目的 比较功能-解剖方法和超声心肌增强方法指导下经冠状动脉消融肥厚心肌（TASH）治疗肥厚型梗阻性心肌病的有效性和安全性。方法 72例药物治疗不佳的肥厚型梗阻性心肌病患者分别采用超声心肌增强（GⅠ,47例）和功能．解剖方法（GⅡ,25例）指导下的TASH治疗。通过对比治疗前后同位素心肌灌注显像、患者主观症状的改善,以及系列超声参数的变化评价不同方法指导下的TASH治疗效果和安全性。结果 两种方法指导下的TASH均能显著降低患者左心室流出道的压力阶差,并显著改善患者主观症状,两组间差异无统计学意义。酒精用量、消融心肌范围、状态以及术后CK-MB峰值两组间差异无统计学意义。心律失常（包括右束支传导阻滞、室性心动过速／心室颤动和临时起搏器依赖）两组发生率相似。GI有6例患者经MCE纠正初选血管（工作初期）。系列的超声心动图长期随访左心室构型变化二组患者间差异无统计学意义。结论 MCE指导下的TASH治疗效应并不优于“功能法”,也不能减少酒精的用量和心律失常并发症,但能有效避免无辜心肌损伤,尤其是开展此项工作的初期。     

Alcohol septal ablation for hypertrophic obstructive cardiomyopathy: a systematic review of published studies

OBJECTIVE: Alcohol septal ablation (ASA) for hypertrophic obstructive cardiomyopathy (HOCM) has emerged as a lesser invasive alternative to surgical myectomy over the past decade. The purpose of this study is to analyze all the published literature on outcomes and complications after ASA. METHODS: MEDLINE and PubMed were searched for all available published literature on ASA (June 1996-June 2005) using the terms hypertrophic obstructive cardiomyopathy (HOCM), alcohol septal ablation for hypertrophic obstructive cardiomyopathy, alcohol septal ablation for HOCM, alcohol septal ablation (ASA), transcoronary alcohol septal ablation for hypertrophic obstructive cardiomyopathy (TASH), transcoronary alcohol septal ablation for HOCM, nonsurgical septal reduction therapy (NSRT), and percutaneous transcoronary septal myocardial ablation (PTSMA). RESULTS: A total of 42 published studies (2,959 patients) were analyzed. Mean age was 53.5 (35.4-72) years with a mean male to female ratio of 1.17. Mean follow-up was 12.7 +/- 0.3 months (1.5-43.2). Absolute ethanol (3 mL) was injected in 1.2 septal perforator arteries. On average, serum CK peaked at 964 units. At 12 months, there was a sustained decrease in resting and provoked LVOT gradient (65.3-15.8 and 125.4-31.5 mmHg, respectively) accompanied by reduction in basal septal diameter (20.9-13.9 mm), improvement in NYHA Class (2.9-1.2), and increase in exercise capacity (325.3-437.5 seconds). Early mortality (within 30 days) was 1.5% (0.0-5.0%) and late mortality (beyond 30 days) was 0.5% (0.0-9.3%). Other complications include ventricular fibrillation (2.2%), LAD dissection (1.8%), complete heart block requiring permanent pacemaker (10.5%), and pericardial effusion (0.6%). A repeat ASA was performed on 6.6% of patients and 1.9% of patients underwent surgical myomectomy with resolution of symptoms. CONCLUSIONS: Literature to date suggests that ASA results in acute and intermediate-term favorable clinical and echocardiographic outcomes. A randomized controlled trial is needed to compare ASA and myomectomy in order to determine which technique provides maximal benefit.     

Dual-chamber pacing in hypertrophic obstructive cardiomyopathy: a comparison of acute and chronic effects

This study describes the acute and chronic effects of dual-chamber (DDD) pacing in 14 consecutive patients with hypertrophic obstructive cardiomyopathy (HOCM), whose symptoms were refractory to drug therapy. Although left ventricular (LV) outflow tract pressure gradients diminished from 106+/-47 to 62+/-33 mm Hg (p<0.001) by temporary pacing, the residual pressure gradients were >30 mm Hg in the majority of those with concomitant reductions in cardiac output. The DDD pacing was judged as insufficient by the acute study in the majority of patients. A dual-chamber pacemaker was, however, implanted in 11 patients, and the chronic pacing effects were evaluated. All symptoms (syncope, fainting, palpitation and dyspnea) subsided within 1 month. Left ventricular outflow tract pressure gradients diminished from 99+/-56 to 21+/-13 mm Hg (p<0.004) at 1 week after, and to 17+/-12 mm Hg (p<0.002) at 1 year after the implantation, as measured by Doppler echocardiography. Echocardiogram showed disappearance of the systolic anterior motion of the mitral valve, and significant regression of the septal hypertrophy (from 18.5+/-4.3 to 15.7+/-4.1 mm, p<0.04). There was no significant correlation between the acute and chronic pacing effects in the reduction of the pressure gradients or symptomatic improvement. These results suggest that DDD pacemaker implantation is an effective treatment without any serious risks for patients with drug-refractory HOCM. The chronic-pacing effect in the reduction of the pressure gradient, the regression of hypertrophy and symptomatic improvement cannot be predicted by the assessment of temporary DDD pacing.     

Comparison of dual-chamber pacing with nonsurgical septal reduction effect in patients with hypertrophic obstructive cardiomyopathy

OBJECTIVES: The aim of the study was to compare the influence of dual-chamber pacing vs. nonsurgical septal reduction on hemodynamic and morphological parameters in patients with obstructive form of hypertrophic cardiomyopathy. METHODS: Nineteen patients with dual-chamber pacing (group I) and 9 patients who underwent nonsurgical septal reduction (group II) were studied at baseline and after a 6-month follow-up. The changes of left ventricular outflow tract gradient and posterior wall thickness (as an index of left ventricular hypertrophy regression) were compared. RESULTS: The baseline left ventricular outflow tract gradient was comparable between group I and group II (77+/-25 vs. 82+/-25 mm Hg, p>0.05). At 6-month follow-up, the left ventricular outflow tract gradient was reduced to a similar level in both groups (28+/-19 vs. 25+/-12 mm Hg, p>0.05). At baseline, posterior wall hypertrophy was comparable between groups (12.9+/-1.7 vs. 13.6+/-2.2 mm, p>0.05). During follow-up, the posterior wall thickness was unchanged in the pacing group (12.9+/-1.7 vs. 12.6+/-1.6 mm, p>0.05), whereas nonsurgical septal reduction induced regression of left ventricular hypertrophy in myocardial region remote from the infarcted septal segment (13.6+/-2.2 vs. 10.5+/-2.3 mm, p<0.003). CONCLUSION: Despite comparable reduction of instantaneous left ventricular outflow tract gradient, the nonsurgical septal reduction decreased posterior wall thickness, whereas pacing did not reduce left ventricular hypertrophy. Thus, regression of left ventricular hypertrophy that appeared solely after nonsurgical septal reduction may reflect the more permanent reduction of left ventricular pressure overload. Thus, not only hemodynamic but also morphological benefit from nonsurgical septal reduction seems to indicate the superiority of this method over dual-chamber pacing.     

Acute and long-term results after transcoronary ablation of septal hypertrophy (TASH). Catheter interventional treatment for hypertrophic obstructive cardiomyopathy.

Aims: To evaluate acute and long-term symptomatic, haemodynamic (at rest and during exercise) and electrophysiological results of transcoronary ablation of septal hypertrophy (TASH), a catheter interventional treatment for hypertrophic obstructive cardiomyopathy. Methods and Results: Sixty-two transcoronary ablations of septal hypertrophy were performed by injection of 4.6+/-2.6 ml 96% ethanol into septal branches in 50 patients with hypertrophic obstructive cardiomyopathy and severe symptoms. Serial left and right heart catheterization, transoesophageal echocardiography and electrophysiological investigations were repeated 2 weeks and 7+/-1 months (n=37) after intervention. Transcoronary ablation of septal hypertrophy led to a reduction in septal thickness, sustained elimination of the outflow obstruction (51+/-41 vs 6+/-10 mmHg at rest, P<0.001; 134+/-48 vs 28+/-32 mmHg, P<0.001, post-extrasystolic), a decrease in left ventricular filling pressures at rest and during exercise and a pronounced clinical improvement. There was no evidence for the creation of an arrhythmogenic substrate as assessed by serial programmed electrical stimulation in 39 patients. However, permanent high-grade atrioventricular block occurred in 17% of the patients. There were two early, but no late deaths during a mean follow-up time of 10. 6+/-5.6 months. Conclusion: Transcoronary ablation of septal hypertrophy is a promising new treatment for hypertrophic obstructive cardiomyopathy in patients with severe symptoms. It should now be compared with alternative treatment strategies in prospective randomized studies.     

Outcome of patients with hypertrophic obstructive cardiomyopathy after percutaneous transluminal septal myocardial ablation and septal myectomy surgery

OBJECTIVES: This study was conducted to evaluate follow-up results in patients with hypertrophic obstructive cardiomyopathy (HOCM) who underwent either percutaneous transluminal septal myocardial ablation (PTSMA) or septal myectomy. BACKGROUND: Controversy exists with regard to these two forms of treatment for patients with HOCM. METHODS: Of 51 patients with HOCM treated, 25 were treated by PTSMA and 26 patients via myectomy. Two-dimensional echocardiograms were performed before both procedures, immediately afterwards and at a three-month follow-up. The New York Heart Association (NYHA) functional class was obtained before the procedures and at follow-up. RESULTS: Interventricular septal thickness was significantly reduced at follow-up in both groups (2.3 +/- 0.4 cm vs. 1.9 +/- 0.4 cm for septal ablation and 2.4 +/- 0.6 cm vs. 1.7 +/- 0.2 cm for myectomy, both p < 0.001). Estimated by continuous-wave Doppler, the resting pressure gradient (PG) across the left ventricular outflow tract (LVOT) significantly decreased immediately after the procedures in both groups (64 +/- 39 mm Hg vs. 28 +/- 29 mm Hg for PTSMA, 62 +/- 43 mm Hg vs. 7 +/- 7 mm Hg for myectomy, both p < 0.0001). At three-month follow-up, the resting PG remained lower in the PTSMA and myectomy groups (24 +/- 19 mm Hg and 11 +/- 6 mm Hg, respectively, vs. those before procedures, both p < 0.0001). The NYHA functional class was also significantly improved in both groups (3.5 +/- 0.5 vs. 1.9 +/- 0.7 for PTSMA, 3.3 +/- 0.5 vs. 1.5 +/- 0.7 for myectomy, both p < 0.0001). CONCLUSIONS: Both myectomy and PTSMA reduce LVOT obstruction and significantly improve NYHA functional class in patients with HOCM. However, there are benefits and drawbacks for each therapeutic method that must be counterbalanced when deciding on treatment for LVOT obstruction.     

Percutaneous transluminal septal myocardial ablation in patients with hypertrophic obstructive cardiomyopathy: immediately and middle-term follow-up results]

OBJECTIVE: To evaluate the immediate and follow-up results of percutaneous transluminal septal myocardial ablation (PTSMA) in patients with hypertrophic obstructive cardiomyopathy (HOCM). METHODS: 15 patients with HOCM refractory to medication successfully underwent PTSMA under myocardial contrast echocardiography. RESULTS: The left ventricular outflow gradients (LVOTG) were reduced significantly (77.93 +/- 22.00) mm Hg to (14.8 +/- 15.0) mm Hg (P < 0.0001) immediately with a mean decrease of (5.75 +/- 2.87) mm Hg (P < 0.001) in left ventricular end diastolic pressure. The scores of SAM and mitral regurgition During a mean of 8.6 +/- 3.8(6-22) months follow-up, the patients heart function (NYHA) were greatly improved(3.4 +/- 0.5 vs 1.1 +/- 0.4, P < 0.001), and disappearance of angina pectoris, and exercise endurance improvement with steady hemodynamic improvement. CONCLUSION: PTSMA is effectively non-surgical treatment method for drug-refractory patients with HOCM.     

Catheter-based septal ablation for symptomatic hypertrophic obstructive cardiomyopathy: follow-up results of the TASH-registry of the German Cardiac Society

INTRODUCTION: In late 1997, the German Cardiac Society set up a multicenter registry to evaluate the acute and mid-term course of all patients (pts.) treated with septal ablation for symptomatic hypertrophic obstructive cardiomyopathy (HOCM). An analysis of the acute results has already been published. We now report on the mid-term course (3-6 months) of 242 pts. registered through September 1999. RESULTS: Follow-up was 92% complete (n=222). During follow-up (mean: 4.9+/-2.3 months), an additional 3 pts. died (in-hospital mortality: 3 pts.). A satisfactory clinical effect was reported by 195 pts. (88%); 27 pts. (12%) remained in NYHA classes III and IV. Overall symptomatic improvement (NYHA class: from 2.8+/-0.7 to 1.7+/-0.7) paralleled the outflow gradient (LVOTG) reduction which was further accentuated as compared with the acute result (Doppler measurement at rest: from 57+/-31 to 25+/-25 mmHg to 20+/-21 mmHg; with provocation: from 107+/-53 to 49+/-40, to 44+/-40 mmHg, p<0.001, resp.). Left atrial (LA) diameter (from 46+/-8 to 44+/-7 mm) and septal thickness (from 20+/-5 to 15+/-5 mm; p<0.001, resp.) were also reduced. Comparing the methods for target vessel selection (i.e., with contrast echo monitoring vs pressurefluoroscopy guidance), at followup clinical improvement and hemodynamic measurements were comparable. CONCLUSION: Clinical success can be achieved by septal ablation, both with the echocontrast guided and gradient-fluoroscopy guided method, in 88% of highly symptomatic HOCM pts. At mid-term follow-up, symptoms, left atrial size and septal thickness are reduced, and outflow gradients are further improved as compared to the acute result.     

Percutaneous transluminal septal artery ablation using polyvinyl alcohol foam particles for septal hypertrophy in patients with hypertrophic obstructive cardiomyopathy: acute and 3-year outcomes.

PURPOSE: To investigate the effect of septal artery occlusion with transluminally delivered polyvinyl alcohol (PVA) foam particles for the treatment of hypertrophic obstructive cardiomyopathy (HOCM). METHODS: Percutaneous septal artery ablation was performed in 18 symptomatic patients (13 men; mean age 60+/-17 years, range 28-89) with drug-resistant HOCM. PVA foam particles were mixed with contrast medium and injected through an angiographic catheter under fluoroscopic control until complete stasis in the septal branch was achieved. Patients were monitored with echocardiography and cardiovascular magnetic resonance imaging. RESULTS: The septal artery was successfully occluded in all patients; no embolization of other coronary branches occurred after infusion of 3 to 8 mL (5.2+/-0.8) of PVA foam particles. The resting pressure gradient was diminished from 83+/-32 to 31+/-35 mmHg (p<0.05). Over a mean follow-up of 44+/-4 months, all patients had symptomatic improvement of their dyspnea and workload without the need for intensified drug therapy. The average NYHA functional class decreased from 3.3+/-0.5 to 1.3+/-0.7 (p<0.0001), with a significant increase in the area of the left ventricular outflow tract (1.3+/-0.2 to 2.6+/-0.2 cm2, p<0.0001). Three instances of transient atrioventricular block occurred, but no complete heart block was produced by the embolization procedure. CONCLUSIONS: Embolization of the septal artery with PVA foam particles appears effective and safe in this series of patients with hypertrophic obstructive cardiomyopathy. The pure ischemic infarction produced by PVA ablation might be the responsible for the lack of complete heart block and the need for permanent pacing.