改良经皮经腔间隔心肌化学消融术治疗肥厚型梗阻性心肌病

目的　观察改良经皮经腔间隔心肌化学消融术 (PTSMA)治疗肥厚型梗阻性心肌病 (HOCM)的疗效。方法　 5例患者在常规PTSMA治疗HOCM方法基础上 ,改良如下操作 :1.简化测压方法 :采用大一号动脉鞘与小一号猪尾管同步测股动脉与左室流入道压。 2 .酒精用量指导 :采用球囊闭塞靶间隔支后造影能充分显示间隔支血管供血范围 (即造影剂呈云雾状渗入心肌 )所需的造影剂量 ,指导消融酒精用量。3.尽量避开靶间隔支高位靠右分支 (右前斜位 30°观察 )消融。结果　 5例患者均获成功 ,术后即刻心导管测静息左室流出道压力阶差由术前的 ( 78 4± 2 5 2 )mmHg降至 ( 11 6± 4 7)mmHg。酒精用量为 3～ 9( 4 8± 2 3)ml,2例发生一过性房室传导阻滞 ,术后半年超声心动图测量室间隔厚度由术前的 ( 19 2± 2 3)mm减至 ( 16 1± 2 4 )mm。结论　适当改良的PTSMA方法简便 ,指导消融酒精用量充分 ,消融疗效肯定 ,可减少并发症发生

Modified Percutaneous Transluminal Septal Myocardial Ablation in Patients with Hypertrophic Obstructive Cardiomyopathy

ObjectiveTo evaluate the effects of modified percu tane ous transluminal septal myocardial ablation (PTSMA) in Patients with hypertrophi c obstructive cardiomyopathy (HOCM). MethodsModified PTSMA was appli ed on 5 patients with HOC M. The main modified procedures included: (1) Pressure measurement: Using 7F per cutaneous catheter introducer set (bigger than usually used one) and 6F pigtail angiographic catheter, the left ventricular inflow pressure and femoral artery p ressure were measured simultaneously; (2) Alcohol dose for ablation. The alcohol dose for ablation is refered to the radiographic agent dose injected for full s howing the area supplied blood by the branch of interventricular septum. (3) Abl ation should be avoided in the higher branch of the first major septal perforato r of the left anterior descending coronary artery. ResultsThe procedure in 5 p atients all got success. The left ventricular outflow (LVOT) gradually dropped from 78 4±25 2 mmHg to 11 6±4 7 mmHg immediately after the procedure. The alco hol dose for ablation was about 3～9 ml. 2 cases occurred temporary third degree AV block. After half year the procedure echocardiography Doppler examination in dicated that the depth of interventricular septum reduced from 19 2±2 3 mm to 1 6 1±2 4 mm. ConclusionsThe Modified PTSMA is safer , more simply, and effective in treatment of severe HOCH patients. The complication rate is lower.