经皮腔内室间隔支微粒球栓塞术在治疗肥厚型梗阻性心肌病中的应用

目的:比较经皮腔内室间隔无水酒精消融术（percutaneous transluminal septal branch anhydrous alcohol ablation, PTSAAA）和经皮腔内室间隔支微粒球栓塞术（percutaneous transluminal septal branch microsphere embolization, PTSBME）在治疗有症状肥厚型梗阻性心肌病患者中的有效性和安全性。方法:采用回顾性研究方法，分析55例应用PTSAAA和PTSBME治疗有症状肥厚型梗阻性心肌病患者的临床资料，其中27例采用PTSAAA，28例采用PTSBME。对比两组患者术后6个月和12个月活动后气促(心功能NYHA分级)、胸闷、胸痛（心绞痛CCS分级）及黑朦等症状改善程度，左心室流出道压力阶差（left ventricular outflow tract pressure gradient, LVOTPG）下降程度，室间隔厚度变化，并发症发生率及12个月随访心血管事件发生率。采用LSD- t、χ 2或Fisher确切概率法比较两组间指标的差异。 结果:与术前相比，PTSAAA组和PTSBME组患者术后6个月和12个月黑朦症状、气促、胸痛、LVOTPG、室间隔厚度、并发症发生率及12个月随访的心血管事件的发生率差异均有统计学意义（ P<0.05）。与PTSAAA组相比，PTSBME组6个月及12个月的心功能NYHA分级、心绞痛CCS分级改善程度及左室射血分数均不劣于PTSAAA组，差异均无统计学意义（ P>0.05）；LVOTPG下降程度和室间隔厚度在术后6个月不劣于PTSAAA组，（16.8±7.5） mmHg vs （15.8±7.3） mmHg，（19.8±4.9） mm vs （17.4±4.1） mm， P>0.05]，差异均无统计学意义；术后12个月优于PTSAAA组，（15.2±6.7） mmHg vs （9.8±5.4） mmHg，（18.4±5.1） mm vs （12.2±3.2） mm， P<0.05]，差异均有统计学意义。与PTSAAA组相比，PTSBME组心血管事件发生率、Ⅲ度房室传导阻滞发生率差异均有统计学意义（6例 vs 1例；5例 vs 0例， P<0.05），安全性优于PTSAAA组。 结论:PTSBME可能是治疗有症状肥厚型梗阻性心肌病患者的一种安全有效手段。

Application of percutaneous transluminal septal branch microsphere embolization in the treatment of hypertrophic obstructive cardiomyopathy

Objective:To compare the clinical efficacy and safety of percutaneous transluminal septal branch anhydrous alcohol ablation (PTSAAA) and percutaneous transluminal septal branch microsphere embolization (PTSBME) in the treatment of patients with symptomatic hypertrophic obstructive cardiomyopathy.Methods:The clinical data of 55 patients with symptomatic hypertrophic obstructive cardiomyopathy treated by PTSAAA and PTSBME were retrospectively analyzed, among whom 27 were treated with PTSAAA and 28 with PTSBME. The changes of postoperative indicators of the two groups of patients were compared, including the improvement degree of symptoms shortness of breath after activity (cardiac function NYHA classification), chest tightness, chest pain (angina CCS classification) and amaurosis, the decrease of left ventricular outflow tract pressure gradient (LVOTPG)], the ventricular septum thickness shown by color Doppler echocardiography, the incidences of complications at postoperative month 6 and 12, and the incidences of cardiovascular events at follow-up month 12. LSD- t, χ 2 or Fisher exact probability methods were used to compare the differences of indicators between the two groups. Results:Compared to the relative indicators before operation, there were significant differences in shortness of breath after activity, chest pain and amaurosis, LVOTPG, ventricular septum thickness, the incidences of complications at postoperative month 6 and 12 and the incidences of cardiovascular events at follow-up month 12 in both the PTSAAA group and PTSBME group ( P<0.05). The PTSBME group was not inferior to the PTSAAA group in the improvement degree of amaurosis, cardiac function NYHA classification and angina CCS classification and left ventricular ejection fraction (LVEF) at postoperative month 6 and 12 ( P>0.05) as well as in the LVOTPG decrease and the ventricular septum thickness at postoperative month 6 (16.8±7.5) mmHg vs (15.8±7.3) mmHg, (19.8±4.9) mm vs (17.4±4.1) mm, P>0.05], but was superior to the PTSAAA group in the LVOTPG decrease and the ventricular septum thickness at postoperative month 12 (15.2±6.7) mmHg vs (9.8±5.4) mmHg, (18.4±5.1) mm vs (12.2±3.2) mm, P<0.05]. There were statistical significances in the incidences of cardiovascular events and third degree atrio-ventricular block and nosocomial mortality between the two groups (6 vs 1; 5 vs 0, P<0.05), and the PTSBME group was superior to the PTSAAA group in safety. Conclusion:PTSBME may be a safe and effective method for the management of patients with symptomatic hypertrophic obstructive cardiomyopathy.