21例梗阻性肥厚型心肌病化学消融治疗近期疗效观察

目的探讨梗阻性肥厚型心肌病化学消融治疗的近期疗效。方法收集肥厚性梗阻性心肌病患者21例,行经皮间隔心肌消融术(PTSMA)。比较患者术前、术中及术后跨左心室流出道压力阶差(LVOTPG)及室间隔厚度。观察患者术后并发症发生情况及临床症状改善情况。结果 (1)患者无水酒精平均用量为(2.1±1.5)ml。患者术后NYHA评分为(1.7±0.6)分,显著低于术前(P<0.05)。(2)与术前相比,患者术中球囊加压后及消融术毕LVOTPG均值均显著降低(P<0.05)。(3)患者消融术毕、术后1周平均室间隔厚度分别为(23.3±5.8)mm和(21.4±4.9)mm,与术前比较差异无统计学意义(P>0.05)。术后3个月平均室间隔厚度为(18.5±4.1)mm,显著低于术前(P<0.05)。(4)患者心肌酶均出现显著升高,12例患者出现心绞痛症状,18例患者出现一过性房室传导阻滞。结论在梗阻性肥厚型心肌病的治疗中,化学消融能够显著降低室间隔厚度及LVOTPG,改善患者临床症状,具有良好的疗效。

Clinical observation on the short-term efficacy of chemical ablation in 21 patients with hypertrophic obstructive cardiomyopathy

Objective To investigate the short-term efficacy of chemical ablation in patients with hypertrophic obstructive cardiomyopathy (HOCM).Methods Twenty-one patients with hypertrophic obstructive cardiomyopathy were chosen,and treated with percutaneous transluminal septal myocardial ablation (PTSMA).Preoperative,intraoperative and postoperative LVOTPG and septal thickness were compared.Postoperative complications and improvement of clinical symptoms were observed.Results The average amount of ethanol used were (2.1±1.5) ml.Postoperative NYHA classification were (1.7±0.6),significantly lower than the preoperative score (P<0.05).Compared with preoperative LVOTPG,the intraoperative mean LVOTPG of patients after balloon pressure and complete ablation were significantly lower (P<0.05).The average septal thickness of patients with complete ablation and one week after operation were (23.3±5.8) mm and (21.4±4.9) mm,with no statistically significant difference compared with the preoperative value (P>0.05).The average septal thickness 3 months after operation were (18.5±4.1) mm,significantly lower than the preoperative one (P<0.05).Four cardiac enzymes were significantly increased,12 patients had symptoms of angina,and 18 patients had transient atrioventricular block.Conclusion In the treatment of HOCM,chemical ablation can significantly reduce septal thickness and LVOTPG,as well as improve clinical symptoms.