经皮腔内室间隔无水乙醇消融术治疗梗阻性肥厚型心肌病急性期疗效评价

The acute effect evaluation of percutaneous transluminal septal myocardial ablation for hypertrophic obstructive cardiomyopathy

目的 :对梗阻性肥厚型心肌病 (HOCM)行经皮腔内室间隔无水乙醇消融术 (PTSMA) ,并应用多普勒超声心动图进行PTSMA治疗前后系列监测 ,初步探讨PTSMA治疗HOCM的安全性及急性期效果。方法 :对8例伴症状性HOCM患者实行PTSMA。多普勒超声心动图分别于术前及术后监测。术中给予第 1或第 2间隔支注射无水乙醇 1.5～ 5 .0ml,同时行左心导管及心电图系列监测。术后急性期连续观察心肌酶谱、心电图 ,测血压 ,检测左室流出道 (LVOT)压差。结果 :①术后并发症 :在PTSMA后 ,5例 (6 2 .5 % )患者发生了束支传导阻滞 ,其中完全性右束支传导阻滞 4例 (5 0 % ) ,均为暂时性阻滞 ;所有患者在出院时束支传导阻滞均已消失 ,无一例安装起搏器。且无一例发生窦性停搏。术后有 2例 (2 5 % )患者出现了低血压 ;8例 (10 0 % )患者均出现了胸痛 ;有 1例患者术后出现了频发室性期前收缩。②LVOT梗阻情况 (压力差的变化 ) :PTSMA后 ,静息时LVOT压力阶差从术前 (4 1.5 8± 13.37)mmHg(1mmHg =0 .133kPa)下降到 (2 4 .0 5± 12 .98)mmHg(P <0 .0 5 )。术前有 6例患者存在收缩期前向运动 (SAM )现象 ,术后有 2例患者SAM现象消失。③左室收缩、舒张功能和左室肥厚 :术前、后患者在室间隔厚度、左室舒张期内径、左室后壁厚度、左房直径、?

Objective:Patients with symptomatic HOCM were performed PTSMA,and applied with Doppler echocardiography to monitor some parameters of pre-and post-PTSMA,in order to evaluate the acute effect and security of PTSMA for HOCM. Method:Eight patients with severe HOCM were treated with PTSMA.NYHA function class was 1.88± 0.64, monitored the patients with doppler echocardiography in pre- and post-intervention.The first or second septal artery supplying the hypertrophic area was injected 1.5 to 5 ml of absolute ethanol. Blood pressure,electrocardiogram and serial left heart catherization were observed during ablation and several days after intervention.Result:① Intervention complications:In 5( 62.5%)patients,a new bundle branch block was present after PTSMA,and 4 (50%)patients appeared complete right bundle branch block among them, which were temporality block.All the patients had no bundle branch block when discharged.No patients with DDD pacemaker implanation after PTSMA.Furthermore,no patients occurred sinus arrest, 2(25%) patients occurred hypotention after intervention,and recovered after using dopamine or dobutamine,appropriate fluid replacement.8(100%)patients appeared chest pain,and relieved after injecting morphine and nitroglycerin.1 patients presented frequent premature ventricular beats,and disappeared after injecting ledocaine.no patients died from PTSMA.②LVOT obstruction:LVOTG at rest was reduced from ( 41.58± 13.37)mmHg to ( 24.05± 12.98)mmHg (P< 0.05)after PTSMA.6 patients had the obstruction-associated phenomena of SAM before intervention,and SAM of 2 patients disappeared after intervention.③Systolic and diastolic LV function and LV hypertrophy: Before and after PTSMA,septal thickness,LV end-diastolic diameter,LV post-wall thickness,left atrial diameter,LV ejection fraction and fractional shortening of the patients with HOCM,had no statistic significance.Conclusion:PTSMA reduce or eliminate LVOT obstruction,symptoms associated with obstruction of patients with HOCM, without openning the chest,and can obtain the similar effect of surgical myectomy with acceptable complication rates. So PTSMA is a safe no-surgical procedure to treat HOCM.