肥厚性梗阻型心肌病化学消融疗效评价

目的探讨肥厚性梗阻型心肌病经皮腔内室间隔消融术的临床意义及其并发症发生情况。方法7例肥厚梗阻型心肌病患者接受经皮腔内室间隔消融术,观察比较术前术后参数指标及心电图变化。结果左室流出道压力阶差由术前65.10±8.32mmHg降至术后的10.76±9.2mmHg,室间隔厚度由术前25.66±3.17mm降至术后的14.36±3.08mm。心肌酶峰值时间为11.2±3.5h。3例出现短阵加速性室速,后转为短暂Ⅲ度AVB。3例为右束转传导阻滞。无胸导联异常Q波发生。结论经皮腔内室间隔消融术可致心律失常发生率高,但多为一过性,只要病例选择适当,靶血管寻找正确,术中观察严密、操作熟练,手术是安全的。

Evaluation of effectiveness of percutanous transluminal septal myocardial ablation in treatment of hypertrophic obstructive cardio-myopathy

Objective To evaluate the early and late effectiveness and complications of percutanous transluminal septal myocardial ablation(PTSMA)treatment of the hypertrophic obstructive cardio-myopathy(HOCM).Methods The7patients were subjected to PTSMA:put 0.014″guiding wire and2.0mm±2.0mm ballon cathether into the first septal artery,measure LV/LO pressure gradient before and after operation,pull out the guiding wire,inject alcohol1.0-1.5ml;observe and compare heart rate,heart thythm,blood pressure,atrio-ventricular block,angina.Results After operated on the patients,LV/LO pressure gradients drop ed to10mmHg.Following up for on year,all the patients with temporary arrhythias had no angina and syncope,average interventricular septum thickness(from25.3mm to15.1mm),average LVOT width(from5.8mm to12.5mm),had no arrhythmias.Conclusion PTSMA may obviously relieve symptoms of patients with HCOM,but its complication is lowrer than surgery.PTSMA is the first choose of treatment of HOCM.