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1.
AIM: The aim of this study was to analyze hemodynamic and clinical outcome in a cohort of 312 patients who were followed up over a period of 12 months after alcohol septal ablation (PTSMA) for symptomatic hypertrophic obstructive cardiomyopathy (HOCM). METHODS AND RESULTS: PTSMA was intended in 337 patients with HOCM (mean age: 54+/-15 years), with 312 procedures completed by injection of 2.8+/-1.2 ml of alcohol. In 25 patients (8%) the intervention was aborted, mostly because of contrast echocardiographic findings. In the 312 patients who received alcohol, permanent pacing was necessary in 22 cases (7%); and in-hospital mortality was 1.3% (four patients). During follow-up, contact to six patients (2%) was lost, and three additional patients (1%) died. The 299 patients who either underwent non-invasive reassessment in our institution or transmitted followup data from their local physician formed the study population. Improvement in symptoms was reported by 272 patients (91%). Mean NYHA functional class was reduced from 2.9+/-0.4 to 1.5+/-0.7 (p<0.0001) along with a gradient reduction (echo-Doppler) from 59+/-32 to 8+/-15 mmHg at rest, and from 120+/-42 to 28+/-32 mmHg with provocation (p<0.0001 each). Exercise capacity improved from 94+/-51 to 119+/-40 watts (p=0.001), and peak oxygen consumption from 18+/-4 to 21+/-6 ml/ kg/min (p=0.01). Younger age and higher outflow gradients at baseline and immediately after intervention were associated with a less favorable hemodynamic outcome. The degree of limitation of exercise capacity at baseline was the only predictor of symptomatic improvement. CONCLUSIONS: Catheter-based septal ablation is an effective non-surgical technique for reducing symptoms and outflow gradients in HOCM. In contrast to a previous study, in this cohort of 312 patients there was no association between post-interventional enzyme release and hemodynamic success. Younger patients with high baseline gradients, however, tended to have a less favorable hemodynamic outcome with higher residual gradients.  相似文献   

2.
Percutaneous transluminal septal myocardial ablation (PTSMA) is an established procedure for treating symptomatic hypertrophic obstructive cardiomyopathy. We report a case of urgent PTSMA for treating refractory heart failure due to exacerbated obstruction of the left ventricular outflow tract after surgical aortic valvular replacement to treat severe aortic stenosis.  相似文献   

3.
In some patients with hypertrophic cardiomyopathy, the dynamic left ventricular outflow tract obstructive gradient results in exercise-limiting symptoms of dyspnea, angina, and syncope. Dual chamber pacing has been proposed as a widely available alternative treatment for a subset of patients with symptomatic hypertrophic obstructive cardiomyopathy. Initial studies showed a reduction in gradient and an improvement in symptoms in almost 90% of patients with severe symptoms. We report the Mayo Clinic experience with dual chamber pacing in 38 patients with hypertrophic obstructive cardiomyopathy who had permanent pacemakers implanted for limiting symptoms intractable to medical therapy. After a mean +/- SD follow-up of 24 +/- 14 months, subjective improvement was reported in 47% of patients. However, there was no statistical difference between the maximal oxygen consumption at last follow-up and AAI pacing (atrial sensing and atrial pacing) (18.6 +/- 1.1 mL.kg-1.min-1) (i.e., when the pacemaker was implanted but not pacing continuously). This article discusses the clinical perspective on the utility of dual chamber pacing for patients with hypertrophic obstructive cardiomyopathy.  相似文献   

4.
目的评价心肌声学造影(MCE)在经皮经冠状动脉心肌化学消融术(PTSMA)治疗肥厚型梗阻性心肌病的应用价值。方法 22例肥厚型梗阻性心肌病患者,术前超声观察二尖瓣前叶收缩期前向运动(SAM征)与室间隔接触点,脉冲多普勒测量左室流出道流速加速点,相应水平肥厚的室间隔确定为梗阻相关心肌(靶域)。术中行冠状动脉超声造影,根据室间隔支发出部位拟定消融血管;行MCE,若心肌显影范围与梗阻心肌范围吻合则确定该室间隔支为支配靶域的消融血管(靶血管),注入无水乙醇行PTSMA治疗。结果 22例患者术中,19例MCE心肌显影部位与术前靶域相吻合,直接行PTSMA治疗;2例MCE显示心肌显影区域小于靶域,更换靶血管后行PTSMA治疗;1例MCE显示非靶域显影而放弃消融治疗。21例患者术后即刻静息左室流出道压差(LVOTPG)下降达50%以上。PTSMA术后1、3、12个月IVST、LVOTG较术前减小(P0.05)。术后1个月SAM评分、二尖瓣反流评分较术前减小(P0.05),术后3个月、1年与术后1个月差异无统计学意义。结论 MCE在PTSMA术中能引导定位定量消融心肌,减少盲目消融导致的非靶域心肌损伤。  相似文献   

5.
化学消融术治疗肥厚型梗阻性心肌病疗效观察   总被引:1,自引:0,他引:1  
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)的中期疗效,以及影响预后的因素。方法33名肥厚型梗阻性心肌病患者入选行PTSMA,术前完善相关检查,术中测量压力阶差,术后定期复查心电图及超声心动图进行跟踪随访。结果每例患者使用无水乙醇量(1.0~9.0)ml,平均(3.6±1.9)ml,消融间隔支数1~3支,平均(1.3±0.6)支。消融术前左室流出道压力阶差(LVOTG)平均为(98.8±35.4)mmHg,消融术后左室流出道压力阶差平均为(16.1±23.5)mmHg,与术前相比差异有统计学意义(P<0.01);消融术前室间隔(IVS)厚度为(25.2±5.7)mm,消融术后2年室间隔厚度为(18.1±3.3)mm,与术前相比差异有统计学意义(P<0.01),消融间隔支数不同者,术后室间隔变薄程度不同(P<0.01);消融术前左心房内径为(45.6±6.6)mm,消融术后2年左房内径为(39.9±4.9)mm,与术前相比差异有统计学意义(P<0.01);消融术前左室内径为(40.9±6.9)mm,消融术后2年左室内径为(46.4±5.2)mm,与术前相比差异有统计学意义(P<0.01)。结论经皮经腔间隔心肌化学消融术能显著降低左室流出道压力阶差,降低室间隔厚度,改善左室舒张功能,降低左房压力,并随着时间延长疗效逐渐增加。  相似文献   

6.
目的评价超声心动图在肥厚型梗阻性心肌病(HOCM)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16例,介入治疗术中引导及监测PTSMA。结果16例均成功实施PTSMA治疗,术后左室流出道流速及压差均有明显下降,临床症状亦均有不同程度改善。结论超声心动图可在术前筛选HOCM患者,术中指导及监测PTSMA,术后评价疗效及随访观察。  相似文献   

7.
目的:探讨超声心动图技术引导肥厚型梗阻性心肌病(HOCM)患者经皮导管肥厚室间隔化学消融术(PTSMA)的可行性及有效性。方法:应用综合超声心动图技术术前筛选HOCM患者5例。介入治疗术中以二维、多普勒和彩色多普勒监测及引导PTSMA。结果:除一例患者因冠状动脉间隔支太细无法消融而终止PTSMA外,余4例均取得良好效果。左室流出道流速及压差均有一不同程度的下降;二尖瓣及其腱索收缩期前向运动现象均有不同程度缓解;二尖瓣近流明显减轻。结论:综合性超声心动图技术可在术前筛选HOCM患者,术中指导及监测PTSMA,术后评价疗效及随访观察。  相似文献   

8.
目的 评估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)近中期疗效.方法 2006年7月至2009年6月,采用Sigwart法对19例(男14例,女5例)症状明显的肥厚型梗阻性心肌病患者进行PTSMA,所有患者均分别于术前、术后1周、术后30天及术后1年接受心脏彩色超声及心电图检查.结果 19例患者手术均成功.术前左心室流出道压差(LVOTPG)均明显高于术后1周、术后30天及术后1年,LVOTPG(92.5±32.4)mmHg vs(36.3±21.6)mmHg、(32.7±24.3)mmHg、(30.1±20.6)mmHg(P<0.05或<0.01).术前室间隔厚度(IVST)明显大于术后30天及术后1年,IVST(21.7±3.6)mm vs(15.4±4.2)mm、(13.4±2.8)mm(P<0.05或<0.01).17例患者术后心功能改善、临床症状明显减轻或消失.4例出现完全性右束支传导阻滞,其中1例术后即恢复,1例发生不完全左束支传导阻滞,无Ⅲ度房室传导阻滞发生.结论 PTSMA是HOCM一种安全、有效的治疗手段,IVST及LVOTPG均呈持续性下降.  相似文献   

9.
目的 探讨桡动脉途径实施经皮室间隔心肌化学消融术(PTSMA) 治疗肥厚型梗阻性心肌病(HOCM)患者的疗效及安全性。方法 回顾性分析通过桡动脉途径接受PTSMA 治疗的32例HOCM患者的临床资料,观察患者术前及术后6个月心脏彩超的左心室流出道(LVOT)宽度、左心室流出道压差(LVOTG)以及室间隔(IVS)厚度等指标,评估PTSMA的疗效,同时观察患者并发症发生情况。结果 32例患者成功完成PTSMA。术后LVOTG由术前(75.17±12.70) mmHg降至(32.42±7.62) mmHg,术后IVS厚度由术前(26.87±4.35) mm降至(17.83±3.27) mm,术后LVOT宽度由术前(6.45±2.34) mm增至(11.23±3.28) mm;术后LVOTG、LVOT宽度以及IVS厚度均优于手术前,差异均有统计学意义(P<0.01)。临床症状显著改善。11例患者术中出现一过性Ⅲ度房室传导阻滞(AVB);术后出现迟发性Ⅲ度AVB的2例患者中,置入双腔起搏器1例。无桡动脉闭塞、心包填塞、出血或急性肺栓塞等并发症,无死亡病例。结论 PTSMA是治疗HOCM患者的可行方法,能够显著降低LVOTG及IVS厚度、改善临床症状,并且桡动脉途径相对安全。  相似文献   

10.
Intracavitary LV obstruction is an important determinant of clinical outcome in hypertrophic cardiomyopathy (HCM). In a minority of patients the obstruction is at the level of the papillary muscles. Mid-cavity obstructive HCM may be associated with a distal LV aneurysm and a worse prognosis. It is often not amenable to standard cardiac surgeryfor LV outflow obstruction. The long-term effects (mean follow-up 4.8+/-2.9 years) of dual chamber (DDD) pacemaker therapy in 14 patients with mid-cavity obstructive HCM (mean age 34+/-16 years, range 15-65 years) were studied. Patients were evaluated by cardiac catheterization at baseline and 6 months to 1 year after receiving DDD pacemakers off all drug therapy. Symptoms were improved in all patients and NYHA functional class reduced from 2.8+/-0.1 to 1.9+/-0.4 (P < 0.0005). Intracavitary LV pressure gradients was reduced significantly (43+/-36 vs 84+/-31 mmHg at baseline, P < 0.0005). There was a significant associated reduction in apical LV systolic pressure (152+/-37 vs 188+/-34 mmHg, P < 0.001). In addition, there was a trend towards increased exercise tolerance (445+/-123 vs 396+/-165). Cardiac output and LV filling pressures were unchanged. In conclusion, chronic DDD pacing results in significant symptomatic and hemodynamic improvement in this uncommon but important subset of patients with obstructive HCM in whom the role of cardiac surgery is less well defined compared with the more typical outflow tract location of LV obstruction.  相似文献   

11.
目的 比较经皮腔内室间隔无水酒精消融术(percutaneous transluminal septal branch anhydrous alcohol ablation,PTSAAA)和经皮腔内室间隔支微粒球栓塞术(percutaneous transluminal septal branch microspher...  相似文献   

12.
间隔化学消融术治疗肥厚型梗阻性心肌病   总被引:2,自引:1,他引:1  
目的:观察经皮腔内间隔心肌化学消融术(percutaneous transluminal septal myocardial ablation,PTSMA)治疗药物难治性肥厚型梗阻性心肌病(hypertrophic obstructive cardiomyopathy,HOCM)的疗效,分析疗效与消融血管的选择、无水乙醇用量之间的关系。方法:对21例HOCM药物疗效欠佳的患者进行PTSMA治疗,其中男性14例,女性7例。消融术前后心导管测量左室流出道压差(left ventricular outflow—tract gradients,LVOTG)。结果:15例手术成功,消融术前后心导管测压LVOTG分别为73.7±32.2mmHg和32.0±26.1mmHg(P〈0.01)。单支血管消融术和多支血管消融术疗效相当.但多支血管消融使术后心肌肌钙蛋白cTnT和肌酸激酶同工酶CK-MB进一步升高(P=0.02和P=0.03)。以无水乙醇用量为横坐标,LVOTG下降为纵坐标做图,当用量在1.5~2.5mL及4mL左右时,LVOTG下降达高峰。线性相关回归分析显示,术后cTnT峰值(y)与无水乙醇用量(x)相关(r=0.526,P〈0.05)。结论:PTSMA治疗HOCM患者的疗效满意.确定靶血管是关键,建议消融单支靶血管的无水乙醇用量以1.5~2.5mL为宜。  相似文献   

13.
目的 探讨彩色超声心动图技术在肥厚型梗阻性心肌病(HOCM)经皮导管肥厚室间隔化学消融术(PTSMA)中的应用价值.方法 应用彩色超声心动图筛选HOCM患者12例,于手术前后监测室间隔厚度(IVST)、左室流出道内径(LVOT)、左室流出道压力阶差(LVOTPG)、冠脉室间隔支血流显像.结果 12例患者成功实施PTSMA,术后1周及1个月各项监测指标较术前有显著改善(P<0.05),术后1个月较术后1周亦有显著改善(P<0.05).结论 应用超声心动图能准确筛选病例,监测评价PTSMA治疗效果,是一种无创有效的检查技术.  相似文献   

14.
Objective  To evaluate the long-term outcome of percutaneous septal ablation (PTSMA) after a previous myectomy. Background  Myectomy usually results in symptomatic improvement and reduction of dynamic obstruction in hypertrophic obstructive cardiomyopathy patients (HOCM-pts.). However, a few pts. remain with severe symptoms and obstruction, and need additional interventions. Methods  We reviewed our database of 450 pts. who underwent PTSMA in our institution, and identified 11 (7 women, 4 men, mean age: 50 ± 14 years) with residual or recurrent NYHA class symptoms ≥III and significant left ventricular outflow obstruction (LVOTO) despite a previous myectomy 4 ± 5 years ago. In-hospital and follow-up data covering 6 ± 4 years, focusing on mortality and morbidity, symptoms, exercise capacity, and echocardiographic measures were collected. Results  PTSMA was performed by injection of 3.6 ± 2.9 ml of alcohol. There was no peri-procedural or late death in this cohort. CK peaked at 614 ± 434 U/l. In addition to two pts. who already had a pacemaker implanted, two more (18%) who both had pre-existing left bundle branch block were pacemaker-dependent after PTSMA. During follow-up, 9 pts. (81%) reported significant and stable improvement. Two pts. (18%) developed progressive class III symptoms until their last follow-up, one of these together with persistent AF and a non-fatal stroke, the other received an ICD for primary prophylaxis and entered our pre-transplant program. Echo-Doppler showed sustained LVOTO elimination without global LV dilatation in all cases. Conclusions  PTSMA is an effective non-surgical option for treating symptoms and residual or recurrent LVOTO after a previous surgical myectomy. The high rate of conduction disturbances in this post-surgical cohort translated into a higher rate of pacemaker dependency after PTSMA.  相似文献   

15.
目的评价肥厚型梗阻性心肌病(HOCM)患者经皮室间隔心肌消融术(PTSMA)的疗效,并应用三维超声心动图(3DE)探讨术后左心房容积的变化特点。 方法34例HOCM患者入选此研究。于术前1周、术后1周及术后1年行超声心动图检查。经常规超声获取左心室舒张末期前后径(LVd)、左心房最大前后径(LAd)、左心室射血分数(LVEF)、室间隔基底段舒张末期最大厚度(IVSd)、左心室后壁舒张末期厚度(LVPWd)、左心室流出道压差(LVOT-PG)等,经3DE获取左心房时间-容积曲线,测量左心房最大容积(LAVmax)、左心房最小容积(LAVmin)及左心房收缩前容积(LAVp),计算左心房排空分数(LAEF)、左心房被动排空分数(LAPEF)及左心房主动排空分数(LAAEF)及左心房扩张指数(LAEI),比较术前、术后各参数的变化特点。 结果与术前相比,术后1周LVOT-PG(54.5±34.5)mmHg(1 mmHg=0.133 kPa)、LVEF(71.4±5.7)%、LAVmax(90.2±36.5)ml、LAVp(73.0±34.0)ml及LAVmin(53.2±28.8)ml均明显减低,差异具有统计学意义(t=4.002、3.234、3.502、3.611、2.253,P值均<0.05);术后1年LVOT-PG(38.3±31.7)mmHg、IVSd(16.7±8.3)mm、LVPWd(11.0±1.9)mm、平均E/e′ 12.0±4.6、LAVmax(80.9±24.8)ml、LAVp(61.3±23.1)ml、LAVmin(42.6±19.5)ml、MI 1.46±1.06均明显减低,差异具有统计学意义(t=5.371、4.165、3.473、3.940、3.655、4.046、4.046、Z=-2.873,P值均<0.01),而LAPEF(25.1±5.1)%升高,差异具有统计学意义(t=-3.270,P<0.01)。与术后1周比较,术后1年LVOT-PG、IVSd、LVPWd、LAVmax、LAVp、LAVmin、MI均明显减低,差异值有统计学意义(t=2.256、5.067、3.137、2.200、2.740、2.016、Z=-2.003,P值均<0.05),而LVd(41.6±4.0)mm、LAEF(48.3±7.9)%及LAPEF升高,差异有统计学意义(t=-2.288、-2.725、-2.907,P值均<0.05)。 结论HOCM患者PTSMA术后左心室流出道梗阻减轻,左心室充盈压降低,二尖瓣反流改善。3DE用于评估左心房大小较二维超声准确而敏感,HOCM患者PTSMA术后各时相LAV逐渐缩小。  相似文献   

16.
While medication is the first line of therapy in obstructive hypertrophic cardiomyopathy, patients who have symptoms refractory to medical treatment or asymptomatic patients with high resting gradients (>or=30 mmHg) may require septal myectomy. Surgical septal myectomy can be performed safely, with excellent survival, relief from symptoms and low morbidity. Alcohol septal ablation is an alternative to surgical treatment, but late outcomes are uncertain. Although both methods of septal reduction relieve left ventricular outflow tract gradients and improve functional status, the need for permanent pacing appears higher with alcohol ablation compared with surgical myectomy. As our understanding of obstructive hypertrophic cardiomyopathy continues to grow, the indications for intervention will evolve. In our practice, septal myectomy remains the gold standard for treatment of obstructive hypertrophic cardiomyopathy.  相似文献   

17.
While medication is the first line of therapy in obstructive hypertrophic cardiomyopathy, patients who have symptoms refractory to medical treatment or asymptomatic patients with high resting gradients (≥30 mmHg) may require septal myectomy. Surgical septal myectomy can be performed safely, with excellent survival, relief from symptoms and low morbidity. Alcohol septal ablation is an alternative to surgical treatment, but late outcomes are uncertain. Although both methods of septal reduction relieve left ventricular outflow tract gradients and improve functional status, the need for permanent pacing appears higher with alcohol ablation compared with surgical myectomy. As our understanding of obstructive hypertrophic cardiomyopathy continues to grow, the indications for intervention will evolve. In our practice, septal myectomy remains the gold standard for treatment of obstructive hypertrophic cardiomyopathy.  相似文献   

18.
BACKGROUND: Percutaneous septal ablation has evolved as an alternative to surgery for reducing symptoms and outflow gradients in patients with hypertrophic obstructive cardiomyopathy. Intraprocedural echo-cardiographic imaging can improve clinical and hemodynamic results. Growing experience with this method has additionally shown that threatening necrosis of the myocardium distant from the septal target region can be detected. METHODS AND RESULTS: Percutaneous septal ablation was performed in 162 patients (80 women, 82 men; aged 54.1 +/- 15.5 years); 131 of whom were targeted by intraprocedural myocardial contrast echocardiography. In 11 patients (7%), an atypical target vessel or a perfusion area distant from the expected septal target region was detected, leading to a target vessel change. Permanent pacing was necessary in 14 patients (9%). Three patients (2%) died. After 3 months, the mean New York Heart Association functional class was reduced in the returning 159 patients from 2.8 +/- 0.5 to 1.3 +/- 1.0 (P <.0001) along with a gradient reduction from 77 +/- 35 to 12 +/- 22 mm Hg at rest, and from 147 +/- 43 to 44 +/- 45 mm Hg with provocation (P < .0001 each). The main reason for unsatisfactory gradient reduction was suboptimal scar placement in the patients treated before the introduction of intraprocedural myocardial contrast echocardiography. CONCLUSIONS: Percutaneous septal ablation is an effective nonsurgical technique for reducing symptoms and outflow gradients in hypertrophic obstructive cardio-myopathy. Echocardiographic guidance adds substantially to safety and efficacy of the procedure and should therefore be considered routinely.  相似文献   

19.
目的 应用多普勒组织成像测量室间隔、后壁和二尖瓣环各点速度.以评价肥厚梗阻型心肌病患者在经皮室间隔化学消融术(PTSMA)前后左室收缩舒张功能的改变.方法 在PTSMA术前、术后急性期对肥厚梗阻型心肌病患者分别测量室间隔、左室后壁和二尖瓣环各点收缩期、舒张期早期和舒张晚期峰值速度.结果 肥厚型心肌病患者术后急性期室间隔、左室后壁和二尖瓣环各点收缩期、舒张期早期峰值速度均较术前减低,差异有统计学意义(P<0.05).舒张晚期峰值也较术前减低,大部分差异有统计学意义(P<0.05).结论 肥厚型心肌病患者PTSMA术后急性期左室长轴收缩功能及主动松弛功能较术前减低.  相似文献   

20.
INTRODUCTION: Transcoronary ablation of septal hypertrophy (TASH) is safe and effectively reduces the intraventricular gradient in patients with hypertrophic obstructive cardiomyopathy (HOCM). To analyze the potential of anti- and proarrhythmic effects of TASH, we studied the discharge rates of implanted cardioverter defibrillators (ICD) in patients with HOCM who are at a high risk for sudden cardiac death. METHODS: ICD and TASH were performed in 15 patients. Indications for ICD-implantation were secondary prevention in nine patients after resuscitation from cardiac arrest with documented ventricular fibrillation (n = 7) or sustained ventricular tachycardia (n = 2) and primary prevention in 6 patients with a family history of sudden deaths, nonsustained ventricular tachycardia, and/or syncope. All the patients had severe symptoms due to HOCM (NYHA functional class = 2.9). RESULTS: During a mean follow-up time of 41 +/- 22.7 months following the TASH procedure, 4 patients had episodes of appropriate discharges (8% per year). The discharge rate in the secondary prevention group was 10% per year and 5% in the group with primary prophylactic implants. Three patients died during follow-up (one each of pulmonary embolism, stroke, and sudden death). CONCLUSION: In conclusion, on the basis of ICD-discharge rates in HOCM-patients at high risk for sudden death, there is no evidence for an unfavorable arrhythmogenic effect of TASH. The efficacy of ICD treatment for the prevention of sudden cardiac death in HOCM could be confirmed, however, mortality is high in this cohort of hypertrophic cardiomyopathy patients.  相似文献   

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