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.     

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.     

Early remodelling of left ventricle and improvement of myocardial performance in patients after percutaneous transluminal septal myocardial ablation for hypertrophic obstructive cardiomyopathy

BACKGROUND: Percutaneous transluminal septal myocardial ablation (PTSMA) reduces left ventricular outflow (LVOT) gradient in patients with hypertrophic obstructive cardiomyopathy (HOCM) and leads to symptomatic improvement. Effects of PTSMA on left ventricular performance are currently unknown. The purpose of this study was to evaluate changes in the left ventricular performance using Doppler index of myocardial performance (sum of isovolumic contractile and relaxation times divided by left ventricular ejection time) and left ventricular remodelling after PTSMA for HOCM. METHODS: Twenty-five patients with symptomatic HOCM underwent echocardiography-guided PTSMA procedure. Clinical and echocardiographic data were collected at baseline and 3 months after PTSMA. RESULTS: PTSMA procedures were uneventful, in one patient (4%), pacemaker implantation was needed for sustained complete heart block after the procedure. At 3-month follow-up, the maximal LVOT gradient decreased from 68+/-39 to 18.6+/-12 mmHg (P<0.001), the provoked maximal LVOT gradient decreased from 128.8+/-59 to 25+/-21.4 mmHg (P<0.001), and basal septal thickness decreased from 21.7+/-4 to 15.2+/-3 mm (P<0.001). The improvement of the index of myocardial performance (from 0.65+/-7 to 0.56+/-11; P<0.001) was associated with neither significant change in left ventricular ejection fraction nor left ventricular ejection time. There was no significant difference in the left ventricular dimension at baseline and at follow-up. All patients reported a significant improvement in symptoms at follow-up, the mean NYHA class decreased from 2.6+/-0.7 to 1.4+/-0.7 (P<0.001), and the number of patients suffering from episodes of syncope or attacks of dizziness decreased from 13 to two during the 3-month follow-up. CONCLUSIONS: PTSMA is a safe, effective and reproducible method in the treatment of highly symptomatic patients with HOCM. This procedure results in a significant relief of symptoms associated with decrease in LVOT gradient and thickness of basal interventricular septum. Positive changes in Doppler IMP suggest possible improvement of left ventricular function.     

Percutaneous transluminal septal myocardial ablation in hypertrophic obstructive cardiomyopathy: Acute results and three-year noninvasive follow-up in 18 patients

OBJECTIVES: To study the acute results and long-term clinical course after percutaneous transluminal septal myocardial ablation (PTSMA) in symptomatic patients with hypertrophic obstructive cardiomyopathy (HOCM). METHODS: In 18 patients (seven women, 11 men; average age 53+/-15 years) with symptomatic and medically refractory HOCM, 1.3+/-0.4 septal branches were occluded with an injection of 3.6+/-1.2 mL of 95% alcohol to ablate the hypertrophied interventricular septum. After three years, noninvasive follow-up results of clinical course, echocardiographic and electrocardiographic findings were determined. RESULTS: The invasively measured left ventricular outflow tract (LVOT) gradients were reduced in all patients, with a mean decrease from 79+/-21 mmHg to 11+/-8 mmHg at rest (P<0.01) and from 136+/-41 mmHg to 49+/-21 mmHg after extrasystole. All patients had angina pectoris for 8 h to 24 h. Eleven patients (61.1%) developed a trifascicular block for 3 min to four days requiring temporary (n=10 [56%]) or permanent dual chamber pacemaker implantation (n=1 [6%]). All patients were discharged after 5.9+/-2.3 days. Clinical, electrocardiographic and echocardiographic follow-up was achieved in all patients after three years (3.1+/-0.5 years). No cardiac complications occurred. Thirteen patients (72%) showed clinical improvement, with a New York Heart Association functional class of 1.5+/-0.8. A further reduction in LVOT gradient was shown in eight patients (44%). CONCLUSIONS: The LVOT gradient was greatly reduced in patients with HOCM undergoing a PTSMA procedure and their symptoms were greatly improved without cardiac complications during three-year follow-up. Possible complications include different degrees of heart block, such as trifascicular blocks, requiring temporary pacemaker implantation. PTSMA is a promising nonsurgical method for the treatment of symptomatic patients with HOCM. Clinical long-term follow-up of a larger series of patients is required to determine the therapeutic significance conclusively.     

Unusual presentation of aortic disease in Marfan syndrome: case report

Percutaneous transluminal septal myocardial ablation (PTSMA) has been a useful therapeutic option for medically refractory patients with hypertrophic obstructive cardiomyopathy (HOCM). Multi-detector row computed tomography (MDCT) has enabled the non-invasive detection of coronary arteries. Therefore, we describe here a patient with HOCM who was treated by PTSMA, and the usefulness of MDCT for its greater certainty and safety for the management of PTSMA.     

肥厚型梗阻性心肌病化学消融术后中长期疗效观察

目的评价经皮经腔间隔心肌化学消融术(PTSMA)治疗肥厚型梗阻性心肌病(HOCM)的中-长期疗效。方法选择2000年11月~2004年8月共11例HOCM的患者,成功地接受了PTSMA治疗,术后超声随访12~48个月以上,随访观察患者的室间隔厚度(IVS)、左心室流出道宽度(LVOT)、无创性左心室流出道压力阶差(LVOTPG)、心功能变化。结果11例患者均成功地实施了PTSMA,术后IVS、LVOTPG和NYHA较术前有显著改善,P<0.000 1,术后随访示IVS术后12个月、48个月较术后1周显著改善,P<0.05。结论PTSMA能显著降低室间隔厚度,改善心功能且稳定,中长期疗效肯定,随术后观察时间的延长疗效有进一步增加的趋势。     

Effects of alcohol septal ablation for hypertrophic obstructive cardiomyopathy on Doppler Tei index: a midterm follow-up

Alcohol septal ablation (PTSMA) improves outflow gradient, left ventricular (LV) diastolic function, and symptoms in patients with hypertrophic obstructive cardiomyopathy (HOCM). Tei index (TI) is a Doppler parameter reflecting both systolic and diastolic LV function. Midterm changes of TI after PTSMA have not been determined up to now. Twenty-seven consecutive patients (mean age 53 +/- 13 years) with symptomatic HOCM underwent PTSMA procedure. Clinical and echocardiographic data were collected at baseline, 6 and 12 months after PTSMA. TI decreased from 0.67 +/- 0.11 to 0.55 +/- 0.06, isovolumic contractile time (ICT) decreased from 74 +/- 20 to 48 +/- 11 ms, isovolumic relaxation time decreased from 146 +/- 25 to 117 +/- 9 ms, and LV ejection time decreased from 330 +/- 42 to 298 +/- 13 ms. LV remodeling was determined by LV dimension increase from 46 +/- 6 to 48 +/- 6 mm and basal septum thickness reduction from 22 +/- 4 to 15 +/- 3 mm. LV ejection fraction decreased from 78 +/- 7 to 73 +/- 6% and maximal outflow gradient decreased from 69 +/- 44 to 15 +/- 11 mmHg. All changes were statistically significant (P <0.01). Symptomatic improvement was characterized by relief of dyspnea (2.5 +/- 0.7 versus 1.4 +/- 0.6 NYHA class; P <0.01) and angina pectoris (2.6 +/- 0.9 versus 0.7 +/- 0.7 CCS class; P <0.01). PTSMA is an effective method of therapy for HOCM. Shortening of TI suggests the improvement of LV myocardial performance in the midterm follow-up.     

Percutaneous transluminal septal myocardial ablation in drug-resistant hypertrophic obstructive cardiomyopathy: 18-month follow-up results.

OBJECTIVE: Surgery has been the only therapeutic option in patients with hypertrophic obstructive cardiomyopathy (HOCM) who are resistant to standard treatment. Percutaneous transluminal septal myocardial ablation (PTSMA) by alcohol-induced occlusion of the septal artery for the reduction of left ventricular outflow tract (LVOT) gradient is a novel method. However, long-term clinical follow-up is insufficient. This study reports the acute and mid-term results after PTSMA in symptomatic patients with HOCM. METHODS: Six patients (4 men and 2 women) with symptomatic HOCM and inadequate response to pharmacologic therapy had their major septal branches ablated with alcohol. Mean duration of follow-up was 1.5 years. RESULTS: There was reduction in LVOT gradient in all patients (100%) with a mean reduction of 50 mmHg. Two patients developed complete heart block (CHB) and 3 patients developed bifascicular block. CHB persisted in 1 patient. Two patients died within 8 days of the procedure; one due to cerebrovascular accident and 1 due to asystole. The patient who died of asystole had CHB but refused permanent pacemaker implantation. CHB reverted in 1 patient and bifascicular blocks persisted in 3 patients. Clinical and echocardiographic follow-up was achieved in the 4 surviving patients after 1.5 years. All surviving patients had LVOT gradient reduction and clinical improvement. CONCLUSION: PTSMA for HOCM is a non-surgical technique for reducing LVOT gradient. Heart blocks are one potential complication, and may require pacemaker implantation. Long-term follow-up and a larger series of patients are required to determine conclusive therapeutic significance.     

肥厚型梗阻性心肌病经酒精室间隔消融术后心脏结构及功能变化

目的 探讨经皮穿刺腔内酒精室间隔心肌消融术（percutaneous transluminal alcohol septal myocardial ablation,PTSMA）对肥厚型梗阻性心肌病（hypertrophic obstructive cardiomyopathy,HOCM）患者心脏结构及功能的影响.方法 收集2006年1月至2012年12月在成都市第三人民医院住院的HOCM患者24例,比较其PTSMA术前、术后3个月及术后12个月的左心室流出道压力阶差、室间隔厚度、左心室后壁厚度、左心房内径、左心室舒张末期内径、纽约心脏病协会（NYHA）心功能分级、左心室射血分数和左心室短轴缩短率的变化.结果 HOCM患者进行PTSMA术后3个月及术后12个月左心室流出道压力阶差、室间隔厚度、左心室后壁厚度、左心房内径、左心室舒张末期内径、纽约心脏病协会心功能分级、左心室射血分数和左心室短轴缩短率与术前比较,差异有统计学意义（P＜0.05）;术后12个月相比术后3个月,以上指标变化差异无统计学意义（P＞0.05）.结论 PTSMA能显著改善HOCM患者左心室流出道梗阻及降低室壁厚度,改善患者心功能,是有效的治疗方法.     

Comparison of percutaneous transluminal septal myocardial ablation versus septal myectomy for the treatment of patients with hypertrophic obstructive cardiomyopathy--a meta analysis

BACKGROUND: The effects of percutaneous transluminal septal myocardial ablation (PTSMA) with septal myectomy in patients with hypertrophic obstructive cardiomyopathy (HOCM) are not thoroughly compared. METHODS: Three articles comparing the effects of PTSMA and septal myectomy treatment for HOCM were identified from a search in Pubmed, and a meta analysis was conducted. RESULTS: 177 patients (86 underwent PTSMA and 91 underwent septal myectomy) were included. Interventricular septum thickness was decreased from 22.1 to 15.1 mm (p<0.05) in PTSMA group and from 22.0 to 13.9 mm (p<0.05) in septal myectomy group; left ventricular end-diastolic dimension was increased from 41.8 to 45.2 mm (p<0.05) in PTSMA group and from 41.8 to 43.9 mm (p<0.05) in septal myectomy group; NYHA class was improved from 3.17 to 1.47 (p<0.05) in PTSMA group and from 2.97 to 1.36 (p<0.05) in septal myectomy group; there were no differences in the two groups. However, left ventricular outflow tract gradient was decreased from 76.0 to 15.7 mm Hg (p<0.05) in PTSMA group and from 74.7 to 9.4 mm Hg (p<0.05) in septal myectomy group and the effect of septal myectomy was better than PTSMA (p<0.05). CONCLUSIONS: The effects of septal myectomy treatment for HOCM are better with regard to relief of LVOT gradient, and lower risk of pacemaker requirement, compared to PTSMA. Large randomized clinical trials further comparing the two treatments are suggested.     

超声心动图在肥厚型梗阻性心肌病中的应用

目的评价超声心动图在肥厚型梗阻性心肌病(HOCM)患者经皮室间隔化学消融术(PTSMA)治疗中的应用价值.方法应用超声心动图筛选HOCM患者17例,介入治疗术中引导及监测PTSMA,术后随访.结果术后即刻导管测量左心室流出道(LVOT)压差较术前减低,差异有统计学意义(P＜0.01).术后4周经胸超声心动图检查,LVOT压差、室间隔厚度和左心室射血分数均较术前明显减低,LVOT宽度均较术前明显增加,均差异有统计学意义(均P＜0.01).术前及术后超声心动图与导管测压所得参数具有良好的相关性(r=0.78;r=0.82,均P＜0.01).结论超声心动图技术可用于指导和监测HOCM患者的PTSMA治疗.     

老年肥厚型梗阻性心肌病消融和起搏器治疗的对照观察

目的比较老年肥厚型梗阻性心肌病患者接受经冠状动脉消融肥厚心肌（TASH）或起搏器治疗的有效性和安全性。方法23例充分药物治疗不满意,心功能Ⅲ级（NYHA）以上的老年肥厚型梗阻性心肌病患者随机接受心肌声学造影指导下的TASH或根据血压优化PR间期的右心双腔起搏器治疗。其中2例接受TASH治疗者并发永久起搏器依赖而安装永久起搏器。对单纯接受TASH（13例）或起搏器（8例）治疗者进行了平均24个月的随访。结果接受两种治疗方法的患者心功能和主观症状积分均得到显著的改善。TASH组心功能由3．2±0．7级改善到1．5±0．5级,综合症状积分由5．9±1．6下降到1．8±0．7,P均〈0．001。起搏器治疗组心功能也由3．0±0．1改善到1．9±0．6级,综合症状积分也由4．5±1．3下降到2．3±1．6,P均〈0．01。综合症状改善程度TASH组明显优于起搏器治疗（4．2±1．5比2．3±1．3,P=0．007）。左心室流出道压力阶差TASH组平均下降了（79．9±35．5）mmHg（1mmHg=0．133kPa,P〈0．001）,起搏器治疗组平均下降了（49．3±37．7）mmHg（P〈0．05）,平均下降率分别为84％和53％。左心室流出道压力阶差下降率〉75％和〈50％TASH组分别有10例和1例,起搏器治疗组分别有4例和3例。TASH组治疗后室间隔厚度、左室舒张末径、收缩末径与术前比较变化显著[分别为（22．2±4．1）mm比（17．1±3．2）mm,（41．5±5．3）mm比（44．7±4．6）mm,（23．5±4．4）mm比（28．3±3．6）mm,P均〈0．05],但没有左室收缩功能异常。随访中,TASH组3例阵发性心房颤动中有2例转为慢性心房颤动,起搏器治疗组中2例阵发性心房颤动中1例发展成慢性心房颤动。结论TASH和起搏器治疗两种方法均能使老年肥厚型梗阻性心肌病患者心功能和综合症状得到显著改善,综合症状改善TASH优于起搏器治疗。TASH显著降低左心室流出道压力阶差,起搏器治疗中等程度降低心室流出道压力阶差。TASH导致的左心室流出道重构不会导致老年肥厚型梗阻性心肌病患者收缩功能的异常和左心室的扩张,但同样存在并发症,甚至严重并发症发生的可能。     

Percutaneous transluminal septal myocardial ablation for hypertrophic obstructive cardiomyopathy; The Chinese experience in 119 patients from a single center

BACKGROUND: Percutaneous transluminal septal myocardial ablation (PTSMA) has been introduced as an alternative treatment for hypertrophic obstructive cardiomyopathy (HOCM). We report on the acute, short- and long-term results of our experiences in 119 patients from a single center in China. METHODS AND RESULTS: PTSMA was performed in 119 patients with symptomatic HOCM (mean age 35.4+/-14.8 years, male 80, female 39). All patients had echocardiography performed prior to the procedure, 2-week post-PTSMA, and 6-month post-PTSMA, and 65 patients had echocardiography repeated at 2-year follow-up. The average left ventricular outflow tract (LVOT) gradient was 67.3+/-7.8 mm Hg before the procedure, and 15.9+/-6.8 mm Hg after the procedure (p<0.05). The thickness of interventricular septum (IVS) was 23.3+/-5.6 mm before the procedure, 18.6+/-4.8 mm 2-week post-PTSMA (p<0.05), and 16.8+/-3.4 mm 6-month post-PTSMA in all of the patients, and 15.6+/-3.1 mm 2-year post-PTSMA in 65 patients. The mean width of LVOT was 6.7+/-2.0 mm before the procedure, 8.2+/-3.4 mm 2-week post-PTSMA (p<0.05), 13.7+/-6.3 mm 6-month post-PTSMA and 15.1+/-2.4 mm 2-year post-PTSMA. The incidence of right bundle branch block development post-PTSMA was 52.9%, and three patients (2.5%) had complete heart block. There was no death. CONCLUSIONS: PTSMA is a promising non-surgical procedure for symptomatic patients with HOCM because of its low risk and its significant hemodynamic, echocardiographic and clinical improvement. The significant therapeutic remodeling period was up to 6 months rather than 2 years following the procedure.     

经皮室间隔化学消融术治疗肥厚梗阻型心肌病

目的评价室间隔化学消融术治疗肥厚梗阻型心肌病在急性期的效果。方法对52例确诊肥厚梗阻型心肌病患者进行经皮室间隔化学消融术治疗,并于术前、术后急性期进行超声心动观察。结果41例患者介入治疗成功,成功率为78.8%。术前超声观察室间隔平均厚度(22.96±5.15)mm,左室流出道压力阶差(LVOTPG)(92.64±38.69)mm Hg(1mm Hg=0.133kPa),术后急性期(4.8±3.2)d,室间隔平均厚度(21.27±4.64)mm,较术前比变薄,P<0.05;LVOTPG(51.79±38.99)mm Hg,较术前明显降低,P<0.001。结论经皮室间隔化学消融术治疗肥厚梗阻型心肌病,在急性期可使室间隔平均厚度降低,收缩期左室流出道压力阶差显著下降。     

经皮腔内室间隔心肌消融术治疗梗阻性肥厚型心肌病57例

目的探讨经皮腔内室间隔心肌消融术治疗梗阻性肥厚型心肌病的方法和疗效。方法自1999年9月至2005年1月利用Sigwart法为57例梗阻性肥厚型心肌病患者行经皮腔内室间隔心肌消融术治疗。在压力监测、超声应用、消融操作、疗效判定以及术后处理等方面做了一些改进。结果每例患者消融共用无水乙醇0.6~9.0mL,分别消融1~5根前间隔支血管;57例患者导管测压示左心室流出道压差(静息和激发)均较术前下降>50%。发射计算机体层摄影对照4例中2例出现室间隔心肌放射性缺损。随访2周到5年,54例患者晕厥、头晕、心绞痛、心悸、气喘等症状消失或较术前改善;2例症状复发,心脏超声各项指标接近术前;1例术后半年内症状及心脏超声各项指标改善满意,一年半后死于扩张型心肌病。症状改善的54例中术后43例进行了半年、34例进行了1年的心脏超声随访,各项指标较术后2周时进一步改善。术中部分患者出现一过性短暂阵发性室性心动过速、房室传导阻滞。4例心电图呈前间隔心肌梗死改变,其中1例伴下壁心肌梗死改变。结论经皮腔内室间隔心肌消融术治疗梗阻性肥厚型心肌病疗效显著。本研究对该疗法应用进行了探索,促使经皮腔内室间隔心肌消融术更趋完善。     

Guiding of Percutaneous Transcoronary Septal Myocardial Ablation in Hypertrophic Obstructive Cardiomyopathy by Myocardial Contrast Echocardiography:

Percutaneous transluminal septal myocardial ablation (PTSMA) by alcohol injection into septal branches (SB) of the left coronary artery has evolved as a promising therapeutic option for selected patients with obstructive hypertrophic cardiomyopathy (HOCM). Originally, probatory balloon occlusion of the target vessel was considered to be predictive for definitive reduction of left ventricular outflow gradients (LVOTG). The need for additional information regarding the exact site and extension of the therapeutic septal infarction is demonstrated by a case report. In this patient, myocardial contrast echocardiography (MCE) was performed prior to alcohol injection and showed that the septal area corresponding to LVOTG formation was supplied by a SB originating atypically from an intermediate branch. PTSMA guided by MCE led to complete LVOTG elimination without sustained rhythm disturbances and with a minimum CK rise.     

Percutaneous transluminal septal myocardial ablation for hypertrophic obstructive cardiomyopathy: long term follow up of the first series of 25 patients

OBJECTIVE: To determine the long term outcome in patients treated with percutaneous transluminal septal myocardial ablation (PTSMA) for hypertrophic obstructive cardiomyopathy (HOCM). DESIGN AND SETTING: Observational, single centre study. PATIENTS: 25 patients (13 women, 12 men, mean (SD) age 54.7 (15.0) years) with drug treatment resistant New York Heart Association (NYHA) class 2.8 (0. 6) symptoms attributed to a high left ventricular outflow gradient (LVOTG) and a coronary artery anatomy suitable for intervention. INTERVENTION: PTSMA by injection of 4.1 (2.6) ml of alcohol (96%) into 1.4 (0.6) septal perforator arteries to ablate the hypertrophied interventricular septum. OUTCOME MEASURES: During in-hospital follow up, enzyme rise, the frequency of atrioventricular conduction lesions requiring permanent DDD pacing, and in-hospital mortality were assessed. Long term follow up (30 (4) months, range 24-36 months) included symptoms, echocardiographic measurements of left atrial and left ventricular dimensions and function, and LVOTG. RESULTS: Mean postinterventional creatine kinase rise was 780 (436) U/l. During PTSMA 13 patents developed total heart block, permanent pacing being necessary in five of them. One 86 year old patient died from ventricular fibrillation associated with intensive treatment (beta mimetic and theophylline) for coexistent severe obstructive airway disease. After three months, three patients underwent re-PTSMA because of a dissatisfactory primary result, leading to LVOTG elimination in all of them. During long term follow up, LVOTG showed sustained reduction (3 (6) mm Hg at rest and 12 (19) mm Hg with provocation) associated with stable symptomatic improvement (NYHA class 1.2 (1.0)) and without significant global left ventricular dilatation. CONCLUSIONS: PTSMA is an effective non-surgical technique for reduction of symptoms and LVOTG in HOCM. Prospective, long term observations of larger populations are necessary in order to determine the definitive significance of the procedure.     

The biphasic course of changes of left ventricular outflow gradient after alcohol septal ablation for hypertrophic obstructive cardiomyopathy

BACKGROUND AND AIM: Alcohol septal ablation (PTSMA) decreases left ventricular outflow gradient (LVOG) and relieves symptoms in patients with hypertrophic obstructive cardiomyopathy (HOCM). The time course of early changes of LVOG has not been clearly determined up to now. METHODS: Doppler echocardiography was used to determine the maximal LVOG. Thirty-nine consecutive patients (24 women; age 55+/-14) were examined at baseline, immediately after the procedure, and 3-5 days, 3 weeks and 3 months thereafter. RESULTS: The baseline LVOG decreased immediately after PTSMA from 73+/-49 mmHg to 13+/-16 mmHg (p<0.01). During the hospital stay (postprocedural period) LVOG increased from 13+/-16 to 37+/-35 mmHg (p<0.01). All the patients were discharged 5-10 days after the procedure. At three-week examination LVOG decreased from 37+/-35 to 25+/-12 mmHg (p<0.01). Three-month survival was 97%. One patient died suddenly one month after PTSMA. At three-month examination LVOG decreased from 25+/-12 to 17+/-14 mmHg (NS). All the patients reported an improvement in symptoms at follow-up. CONCLUSIONS: The immediate decrease of LVOG after PTSMA procedure caused by myocardial necrosis and stunning, was followed by a significant LVOG increase during the early postprocedural period and continuous LVOG decrease at the short-term follow-up.     

肥厚梗阻型心肌病化学消融术中、术后严重并发症及防治

目的 :报告经皮室间隔心肌化学消融术治疗肥厚梗阻型心肌病术中、术后出现的严重并发症 ,探讨其原因和机制 ,总结经验、教训 ,以期减少其发生。方法 :2 0例肥厚梗阻型心肌病患者用Sigwart法行化学消融术 ,观察术中、术后出现的严重并发症。结果 :2 0例患者中合并下壁急性心肌梗死 2例 ,前壁心肌梗死 1例 ;术后心室颤动 1例 ;永久性Ⅲ度房室传导阻滞 1例 ;术后严重血流动力学障碍 1例 ;术中左冠状动脉回旋支栓塞 1例。结论 :肥厚梗阻型心肌病化学消融术中及术后可发生多种严重并发症 ,明确靶血管与消融心肌之间的关系、选择恰当的一支或多支间隔支动脉行化学消融 ,是减少并发症的关键     

经皮腔内冠状动脉室间隔化学消融术治疗梗阻性肥厚型心肌病的近期疗效观察

目的评价经皮腔内冠状动脉室间隔化学消融术治疗梗阻性肥厚型心肌病的近期疗效。方法选择梗阻性肥厚型心肌病患者29例,利用Sigwart法行经皮腔内冠状动脉室间隔化学消融术,99%无水酒精注入间隔支,并记录注入前后即刻左心室流出道压力阶差和心电图的变化。在消融术前及术后30天通过超声心动图测量室间隔厚度及左心室舒张末直径。结果间隔支内平均酒精注射量为2.97 mL;术后即刻左心室流出道压力阶差平均下降到36.0±9.3 mmHg;术后30天室间隔厚度降低3.2±0.3 mm;2例需要再次另外一支间隔支消蚀;3例患者术中出现一过性完全性房室传导阻滞;所有患者临床症状都有不同程度的缓解。结论经皮腔内冠状动脉室间隔化学消融术能显著降低左心室流出道压力阶差,治疗梗阻性肥厚型心肌病的近期疗效可靠,但应该严格控制适应症,以减少严重并发症发生。