经皮经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

目的评价经皮经冠状动脉室间隔化学消融术（PTSMA）治疗梗阻性肥厚型心肌病（HOCM）的近期疗效。方法自1998年8月～1999年11月收治HOCM34例，入选行PTSMA26例。利用Sigwart法行PTSMA，注入96%～99%无水酒精消融间隔支前后记录左室流出道压力阶差变化、心电图变化。在消融前及术后2周通过超声心动图测量室间隔（IVS）厚度及左室流出道宽度。结果术前平均静息左室流出道压力阶差为（72.8±24.6）mmHg（1mmHg=0.133kPa），术中球囊加压后为（30.6±18.5）mmHg，术后为（24.3±17.6）mmHg，差异有显著性（P<0.001）。术前室间隔平均厚度为（23.00±6.03）mm，术后2周为（20.55±5.38）mm。术前左室流出道宽度为（6.54±2.36）mm，术后2周为（11.36±3.37）mm（P<0.01）。术前心功能（NYHA分级）为3.4±0.6，术后2周为1.6±0.8。术后CPK与CPK-Mb峰值分别为（1050±514）U/L与（131±78）U/L。术中及术后可见短阵室速、结性逸搏心律、三度房室传导阻滞及束支传导阻滞。1例发生永久性三度房室传导阻滞，安装永久性双腔起搏器。出现下壁及前壁心肌梗死心电图表现者各1例。结论PTSMA能显著降低左室流出道压力阶差，治疗HOCM的近期疗效可靠，但尚需进一步完善方法，以减少严重并发症发生，并需继续随访其中、远期疗效。

Short -term efficacy of percutaneous transluminal septal myocardial ablation on hypertrophic obstructive cardiomyopathy

Objective　To evaluate the short-term efficacy of percutaneous transluminal septal myocardial ablation (PTSMA) on hypertrophic obstructive cardiomyopathy (HOCM). Methods　Thirty-four patients with HOCM were hospitalized from August, 1998 to November, 1999. Among them 26 patients underwent PTSMA by Sigwart method. The changes of left ventricular outflow-tract gradient (LVOTG) and EKG were measured before and after septal branches occluded by 96%－99% alcohol. The thickness of septal myocardium and width of LVOT were also measured before and 2 weeks after PTSMA. Results　LVOTG was (72.8±24.6) mm Hg and (24.3±17.6) mm Hg before and after ablation respectively (P<0.001). The thickness of septal myocardium reduced from (23.00±6.03) mm to (20.55±5.38) mm. The width of LVOT expanded from (6.54±2.36) mm before ablation to (11.36±3.37) mm 2 weeks after ablation (P<0.01 ). NYHA functional class improved from 3.4±0.6 before ablation to 1.6±0.8 two weeks after ablation.Maximal CPK and CPK-Mb were (1 050±514) IU/L and (131±78) IU/L respectively. Nonsustained ventricular tachycardia, bradyarrythmias, bundle branch block and trifascicular blocks were observed during and after ablation. DDD pacemaker was implanted in one patient because of permanent complete heart block. Posterior and anterior wall myocardial infarctions were observed in one patient respectively. Conclusion　PTSMA can significantly reduce LVOTG and has a satisfactory short-term efficacy in the treatment of HOCM. Further studies on middle and long-tern efficacy should be done.