经皮间隔心肌消融术治疗3例肥厚型梗阻性心肌病

目的评价经皮经腔间隔心肌消融术(percutaneoustransluminal septal myocardial ablation,PTSMA)治疗肥厚型梗阻性心肌病(hypertrophic obstructive cardiomyopathy,HOCM)的即刻和近期疗效,并探讨相关并发症的防治.方法对3例药物治疗效果不佳的HOCM患者,进行经皮经腔间隔心肌消融术治疗,由压力监测判断即刻疗效,术后半年则由患者临床症状及超声心动图评价近期疗效.结果室性早搏激发的左室流出道压力阶差术前平均143 mmHg(70～180 mmHg),术后平均53 mmHg(30～80 mmHg),下降幅度平均78%(69%～85%).3例中有1例出现完全性房室传导阻滞伴交界性逸搏心律,另有1例出现完全性右束支传导阻滞.3例均于术后6个月随访,其心绞痛症状基本消失,心功能明显改善,室间隔肥厚和SAM现象明显减轻.结论对于药物治疗效果不佳的HOCM患者,可采用PTSMA,其近期疗效良好.     

经皮经腔间隔心肌消融术治疗肥厚型梗阻性心肌病的临床观察

厚型梗阻性心肌病(HOCM)经皮经腔间隔心肌消融术(PTSMA)是近年来介入治疗的一个崭新的领域.我院共收治 12 例患者,现报告如下.     

肥厚型梗阻性心肌病室间隔心肌化学消融术的临床研究现状及进展

肥厚型梗阻性心肌病(hypertrophic obstructive cardiomyopathy, HOCM)是一种常染色体显性遗传性疾病,通常以室间隔非对称性肥厚造成动态性左心室流出道梗阻为主要特征,导致部分患者进展性心力衰竭和猝死.     

肥厚型梗阻性心肌病室间隔心肌化学消融术的疗效探讨

目的探讨经导管室间隔心肌化学消融术(PTSMA)治疗肥厚型梗阻性心肌病(HOCM)的近期疗效.方法 5例重症HOCM患者施行了PTSMA术,随访3～12个月,观察临床症状,超声心动图测定左室流出道压力阶差(LVOTPG)、室间隔厚度(IVST)、左室舒张末直径(LVDD).结果临床症状明显缓解.LVOTPG显著降低,术前(13.8±1.4) kPa,术后即刻(4.7±1.2) kPa,术后3个月(2.9±0.9) kPa;IVST明显变薄,术前(22±2) mm,术后1周(20±3) mm,术后3个月(17±2) mm;LVDD有效扩大,术前(41±4) mm,术后1个月(46±3) mm,术后3个月(48±3) mm.未发生永久性Ⅲ度房室传导阻滞.结论 PTSMA是治疗HOCM的有效手段,其近期疗效良好.     

肥厚型梗阻性心肌病间隔心肌消融术后心律失常观察

心律失常是肥厚梗阻型心肌病(hypertrophic obstruetive cardiomyopathy,HOCM)经皮间隔心肌消融术(percutaneous transluminal septal myocardial ablation,PTSMA)治疗的主要并发症.现总结5例患者PTSMA前、后心电图检查结果.     

肥厚型梗阻性心肌病间隔心肌消融术后心电图变化

心律失常是肥厚型梗阻型心肌病 (ＨＯＣＭ)经皮间隔心肌消融术 (ＰＴＳＭＡ)治疗后的主要并发症 ,１２导联心电图和动态心电图监测是最为实用的诊断手段。现总结５例患者ＰＴＳＭＡ前、后心电图检查结果。１．１一般资料正规药物治疗后仍有明显症状并愿意接受ＰＴＳＭＡ术的ＨＯＣＭ住院患者５例 ,其中男性３例 ,女性２例。年龄２８～５０岁 ,平均３９岁。所有患者均长期服用β 受体阻滞剂和／或钙拮抗剂４８～７２ｈ以上。１．２方法局部麻醉下完成ＰＴＳＭＡ术后 ,手术过程中监测Ⅰ、Ⅱ、Ⅲ、ａＶＦ及Ｖ １导联心电图 ,术中使用类似ＰＴＣ…     

经皮室间隔心肌化学消融术治疗肥厚型梗阻性心肌病疗效评价

目的 评价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)近期疗效 ,并探讨其方法学。方法 31名HOCM患者接受PTSMA治疗 ,6例采用心肌声学造影监测判断消融靶血管。结果 31例患者均成功实施PTSMA治疗 ,患者术前平均跨左心室流出道压力阶差 (71.6±25.7)mmHg,术中球囊充盈15min后为 (29.1±15.6)mmHg,消融术毕为 (21.6±7.7)mmHg,与术前比较均有显著下降 (均P<0.05) ;临床状况显著改善18例 ,明显改善9例 ,改善不显著4例 ;1例患者发生迟发性高度房室传导阻滞 ,经积极药物处理后传导阻滞消失 ,无死亡和需行永久性起搏治疗者。 结论 PTSMA手术是HOCM患者一项有效、相对安全的治疗方法。     

肥厚型梗阻性心肌病化学消融术所致室内传导阻滞的临床特点

目的：研究肥厚型梗阻性心肌病（HOCM）患者给予经皮经腔间隔心肌化学消融术（PTSMA）治疗后室内传导阻滞的临床特点。方法选择2004年1月-2012年12月在辽宁省人民医院行PTSMA的HOCM患者200例为研究对象。监测PTSMA术中及术后患者12导联心电图的变化,分析出现的室内传导阻滞类型及特点。结果术中及术后共有100例患者新发室内传导阻滞。其中完全性右束支传导阻滞者共90例,30例（33.3%）是永久性束支传导阻滞;完全性左束支传导阻滞者10例,其中1例（10.0%）为永久性束支传导阻滞。结论 PTSMA术中及术后出现的室内传导阻滞中,易发生完全性右束支传导阻滞,并且传导系统恢复时间较长,不易发生完全性左束支传导阻滞,如果出现完全性左束支传导阻滞,也多为一过性,其传导系统可迅速恢复。     

经皮经腔间隔心肌化学消融术治疗肥厚型梗阻性心肌病的近期疗效探讨

目的 探讨分析肥厚型梗阻性心肌病(HOCM)患者行经皮经腔间隔心肌化学消融术(PTSMA)的近期疗效.方法方便选取该院2013年10月―2015年10月期间收治的60例HOCM患者,所有患者均行PTSMA,并分别给予术前、术后30 d心电图检查.观察患者的心功能分级、LVOT及LVOTPG.结果患者术后30 d的心功能分级为(1.8±0.6)级,LVOT为(17.8±7.6)mm,LVOTPG为(32.7±24.2)mmHg,与术前的(2.9±0.6)级、(4.2±2.0)mm、(92.5±32.5)mmHg相比,差异有统计学意义(P<0.05).结论在HOCM的临床治疗中,PTSMA治疗效果较好,具有安全、可靠的特点,值得临床推广应用.     

经皮间隔心肌消融术治疗梗阻性肥厚型心肌病的近期疗效观察

目的:评价经皮间隔心肌消融术(PTSMA)治疗梗阻性肥厚型心肌病(HOCM)的近期疗效及安全性。方法:对我院自2000年7月以来收治的6例HOCM患者行PTSMA术,分别在术前、术后及3个月后行超声心动图,记录室间隔厚度及左室流出道压力阶差(LVOTG)。结果:6例PTSMA手术均获成功,术后自觉症状明显缓解,心功能恢复为Ⅰ~Ⅱ级。LVOTG术前平均(94.0±40.8)mmHg,术后即刻(33.7±18.7)mmHg,术后3个月(32.5±12.9)mmHg,差异有统计学意义(P<0.05)。室间隔厚度术前平均(25.6±7.3)mm,术后1周(19.7±3.8)mm,术后3个月(15.5±4.2)mm,术后3个月与术前比较,差异有统计学意义(P<0.05)。1例发生一过性Ⅲ°房室传导阻滞,2 h后恢复正常,2例发生完全性右束支传导阻滞。结论:PTSMA是HOCM的一种有效治疗方法,近期疗效好,但其远期疗效仍需进一步观察。     

Complications of percutaneous transluminal septal myocardial ablation in hypertrophic obstructive cardiomyopathy

目的：评价非手术疗法,即经皮穿刺间隔心肌消融术治疗肥厚型梗阻性心肌病（HOCM）并发症。方法：72名有流出道梗阻症的病人,术前经心脏超声动图明确诊断。病人被施行导管手术,以无水酒精注入靶血管内。观察并发症并分析其可能的原因。结果：在主入酒精时,69名病人发生严重胸痛,在手术及术后围手术期间,19名病人有不同程度的心脏传导阻滞,其中一名病人呈现永久性完全房室传导阻滞,需植入永久性直搏器。束枝传导阻滞在本研究中非常常见,暂时性右束枝传导阻滞占50％,永久性右束枝传导阻滞占38.9％。6例（8.3％）发生急性下壁心肌梗死,一例（1.4％）发生急性前壁心肌梗死。在超过二年的长期随访组中,24例病人无一例死亡,至目前为止,该组病人的心功能没有进行性恶化。在本研究中,无论长期及近期观察,均无死亡发生。结论：心肌消融治疗肥厚型梗阻性心肌病最普遍的并发症是右束枝传导阻滞。最重要的并发症是心脏传导阻滞。心肌消融治疗方法是治疗HOCM的一种良好的非外科手术疗法。     

梗阻性肥厚型心肌病无水酒精室间隔消融术中的并发症及处理

目的：总结梗阻性肥厚型心肌病（ＨＯＣＭ）无水酒精室间隔消融术中并发症及处理，以提高对其术中并发症的认识及处理的水平。方法：对１３ 例ＨＯＣＭ 患者行无水酒精室间隔消融术，注射无水酒精量为１．５～５ ｍ ｌ。消融成功率达１００％ 。结果：术中并发症９／１３ 例次，发生率６９．２％ ，其中以术中注无水酒精时血压下降为最严重，心绞痛最多见。结论：无水酒精室间隔消融术，虽有很好的临床效果，但也会引起一些并发症，如处理不当，甚至会造成死亡，应引起重视     

经皮间隔心肌化学消融治疗7例肥厚梗阻型心肌病的近期疗效观察

目的　评价我院采用PTSMA治疗 7例HOCM的近期疗效。方法　男 4 ,女 3例 ,平均年龄 (36 .6± 11)岁 ,测定静息时左心室与主动脉压差≥ 6 6 7kPa或应激压差≥ 9 33kPa,用球囊堵塞靶间隔支后压差下降和 /或杂音减轻 ,确定为靶血管。第 1间隔支消融 4例 ,第 2间隔支 2例 ,第 1和第 2支间隔支同时消融 1例 ,平均注射无水乙醇 (2 .0± 0 .8)ml。术后随访 (73± 37)d。结果　术后 7例梗阻等症状减轻或消失 ,NYHA分级增加Ⅰ～Ⅱ级 ;心脏超声示室间隔厚度由 (30 .14± 3.85 )mm降至 (2 4 .86±4 .6 7)mm(P =0 .0 0 18) ,左室流出道宽度由 (9.5± 2 .0 5 )mm增至 (14 .34± 3.19)mm(P =0 .0 0 3) ,左室与主动脉压力阶差由(9 .2 5± 1.74 )kPa降至 (4.4 3± 0 .85 )kPa(P =0 .0 0 0 8)。术中及住院期间完全性右束支阻滞 2例 ,窦性心动过缓 2例 ,房室传导阻滞及频发室性早搏 3例。 7例术后心肌酶谱均明显升高 ,最高CK(12 6 6± 6 15 )U。 1例因间歇性Ⅱ度Ⅱ型房室传导阻滞伴晕厥 ,于术后第 7天植入双腔心脏起搏器 ,1例遗留完全性右束支阻滞。结论　PTSMA是一项治疗HOCM的新技术 ,其近期疗效可靠 ,远期疗效有待于进一步观察。     

Percutaneous transluminal septal myocardial ablation in patients with hypert rophic obstructive cardiomyopathy

Objective To evaluate theimmediate and follow-up results of percutaneous transluminal s eptal myocardial ablation (PTSMA) in patients with hypertrophic obstructive cardiomyo pathy (HOCM). Methods Fifteen symptomatic, drug-refractory patients with HOCM underwent PTSMA procedu res with application of a myocardial contrast echocardiography (MCE) intra-proc edure. Before and after the procedure, clinical evaluations were obtained in al l patients, who were followed up for a mean period of 8. 6±3. 8 (6-20) months. Results Immediate left ventricular outflow tract gradient (LVOTG) reduction was achie ved (77. 93±22 mm Hg vs 14. 8±15 mm Hg, P&lt;0. 0001) after the procedure with a mean decrease of5. 75±2. 87 mm Hg of left ventricular end diastolic pressure (P&lt;0. 001). Follow up results revealed that ventricular remodelli ng occurred mainly 1-3 months after the procedure, but without evidence of ventr icular dilation and contract dysfunction. Heart function (NYHA) was greatly imp roved （3. 4±0. 5 vs 1. 1±0. 4, P&lt;0. 001) and exercise endurance increased . A renewed increase of LVOTG was found in 2 patients during follow-up. Conclusions LVOTG was greatly decreased in HOCM patients undergoing a PTSMA procedure, and t heir symptoms were greatly improved without cardiac complications during follow -up. Sub-selection and re-opening of target vesselswere the causes of rene wed increase of LVOTG, and this can be avoided with the accumulation ofexperie nce. This is a promising method for the treatment of symptomatic patients with HOCM.     

Acute and mid-term results of pecutaneous transluminal septal myocardial ablation in patients with hypertrophic obstructive cardiomyopathy

Objective: To assess the acute and mid-term results of cardiac function improvements and left ventricular outflow tract gradient (LVOTG)changes in 30 patients displaying hypertrophic obstructive cardiomyopathy (HOCM) treated with percutaneous transluminal septal myocardial ablation (PTSMA). Methods: PTSMA was intended for 32 patients comprising of 13 women and 19men (average years being 54.1 ± 15.5) to be treated in accordance with the following inclusion criteria: The New York Heart As-sociation(NYHA) definition for cardiac functional class Ⅲ or Ⅳ , or class Ⅱ but for whom medical therapies were not tolerated or with syncope; intraventricular septal (IVS) and left ventricular posterior wall (LVPW) hypertrophy asymmetrically associated with ratio of IVS to LVPW≥1.3 and LVOTG≥50 mm Hg at rest or ≥100 mm Hg at provocation (Valsalva maneuver). The target vessels were determined by coronary arteriography that demonstrated more than one septal branch and probatory balloon occlusion produced greater than 50% decrease of LVOTG. Once the target vessel established, the alcohol was administrated into septal ventricular via over-the-wire balloon. LVOTG was assessed by means of echocardiography measurements immediately after procedure and 3 months. Simultaneously, cardiac function class was also evaluated. Results: Two patients were abandoned prior to intervention due to inappropriate septal target vessels and DDD Pacemakers were chosed. Immediately after the procedure, resting LVOTG was reduced from 73.8 ± 35.5 to 16.6 ± 7.8 mmHg, at provocation LVOTG from 149.3 ± 42.5 to 61.9 ± 43.0 mmHg(P ＜0.0001 each) by echocardiography measurements. After 3 months, the mean New York Heart Association class was reduced from 2.8 ± 0.6 to 1.1 ± 1.0(P ＜ 0.0001) and the LVOTG also remained decrease(28.5 ± 6.4 mmHg at rest and 75.3 ± 11.6 mmHg at provocation). Conclusion: PTSMA is a promising nonsurgical technique for relief of symptoms and reduction of LVOTG in hypertrophic obstructive cardiomyopathy.     

Midterm outcomes of percutaneous transluminal septal myocardial ablation in patients with hypertrophic obstructive cardiomyopathy refractory to medication

Hypertrophic obstructive cardiomyopathy （HOCM） is a genetic disorder characterized by severe asymmetric hypertrophy of the interventricular septum （IVS） in the absence of any other systemic or cardiac diseases. The predominant abnormal haemodynamics are caused by increased left ventricular outflow tract pressure gradient （LVOTG） and abnormal systolic anterior motion of mitral valve.