经皮室间隔心肌化学消融治疗肥厚型梗阻性心肌病近期疗效观察

目的:评价经皮室间隔心肌化学消融(PTSMA)方法治疗的6例肥厚型梗阻性心肌病(HOCM)近期疗效观察。方法:6例肥厚型梗阻性心肌病患者,男4例,女2例;平均年龄(38.6±12)岁;病程(1~7)年,采用RAO 15°~45°体位投照下,确定靶血管后,向球囊导管中心腔内注入无水酒精,均放置临时起搏器,术中密切观察患者的心电图以及LVOTG的变化,术后所有患者均定期复查心电图及超声心动图,随访观察6个月。结果:术中消融第一间隔支者4例,消融第二间隔支者2例。术中有1例出现Ⅲ度房室传导阻滞,2例出现完全性右束支传导阻滞,均为一过性;随访观察6个月,所有患者均存活,无晕厥及心绞痛复发;经常规心电图及动态心电图观察,均无频发室早、短阵室速及其他恶性心律失常出现,复查超声心动图均提示原先肥厚的室间隔心肌变薄,搏动减弱,LVOTG下降,SAM现象消失,左室射血分数提高。结论:PTSMA治疗肥厚型梗阻性心肌病可使室间隔变薄,压力差降低,左室流出道梗阻减轻,患者术后的症状、体征以及超声心动图表现均较术前有显著改善,无严重并发症出现。这表明PTSMA是一种治疗HOCM的有效方法,其近期疗效可靠。

Recently Effects on Percutaneous Transluminal Septal Myocardial Ablation in Hypertrophic Obstructive Cardiomyopathy

Objective: To evaluate the recently effects of percutaneous transluminal septal myocardial in hypertrophic obstructive cardiomyopathy.Methods:6 patients(male 4,female 2,mean aged 38.6 12) with hypertrophic obstructive cardiomyopathy satisfied with certain criteria were treated by alcohol septal ablation.Results: All patients had a good improvement of symptoms and signs significantly;the cardiac function increased I-II grade.They were still surviving during following up 6 months,while we found the better CEG expression,the thin septal myocardium and lower LVOTG.Conclusions: Percutaneous transluminal septal myocardial ablation(PTSMA) is a better way for treatment of hypertrophic obstructive cardiomyopathy in recently effect.It is a safe and there are not risk of sudden dead,infarction and arrhythmia in PTSMA.But longer effects of treatment with PTSMA are still not clean.