经皮室间隔心肌消融术治疗老年肥厚型梗阻性心肌病的临床分析

目的　探讨经皮室间隔心肌消融术治疗老年肥厚型梗阻性心肌病 (HOCM)的可行性 ,安全性和近期效果。方法　对 6 0岁以上的 6例老年HOCM患者施行心肌声学造影指导下的经皮室间隔心肌消融术治疗。结果　 6例患者的经皮室间隔心肌消融术均获成功 ,未出现严重的心脏并发症 ,术后即刻应用心导管测左室流出道压差由术前(10 4.33± 19.6 1)mmHg降至 (35± 2 5 .88)mmHg(P <0 .0 0 1)。术后对 6例患者进行了 1～ 18个月的随访 ,经超声心动图测左室流出道压差由术前 (91.83± 2 7.17)mmHg降至 (36 .0 8± 33.6 3)mmHg(P <0 .0 5 ) ,室间隔厚度由术前(2 1.83± 2 .79)mm降至 (16 .0 2± 3.86 )mm (P <0 .0 5 )。术后心功能由术前的 3.4± 0 .5级改善为 1.1± 0 .3级 (P <0 .0 0 1)。结论　经皮室间隔心肌消融术治疗老年HOCM患者的即刻和近期效果良好 ,并发症少 ,安全性高。

Percutaneous transluminal septal myocardial ablation in treatment of elderly hypertrophic obstructive cardiomyopathy

Objective To investigate the feasibility,safety and short-term effectiveness of percutaneous transluminal septal myocardial ablation(PTSMA) in treatment of elderly hypertrophic obstructive cardiomyopathy(HOCM).Method Using the myocardial contrast echography(MCE),PTSMA was performed in six patients over 60 years old with HOCM.Results All the procedures were successful.No patients died and no severe cardiac complications occurred.Tested by catheter,the left ventricular outflow tract(LVOT) gradient reduced from 104.33±19.61 mmHg before operation to 35±25.88 mmHg(P<0.001).During 1-18 month follow-up,the LVOT gradient reduced from 91.83±27.17 mmHg before operation to 36.08±33.63 mmHg(P< 0.005) and the septal thichness reduced from 21.83±2.79 mm before operation to 16.02±3.86 mm(P<0.05) examined by echo.The heart function improved from grade 3.4±0.5 to grade 1.1±0.3(P< 0.001). Conclusion Short-term results of PTSMA in treatment of elderly HOCM patients are encouraging with high safty and effectiveness.