儿童梗阻性肥厚型心肌病患者四例行化学消融的疗效及安全性初探

Effectiveness and safety of percutanous transluminal septal myocardial ablation in 4 pediatric patients with hypertrophic obstructive cardiomyopathy

目的总结儿童(年龄≤14岁)梗阻性肥厚型心肌病(HOCM)患者行经皮室间隔心肌化学消融术(PTSMA)治疗的并发症发生情况及临床疗效,初步探讨儿童HOCM患者行PTSMA的疗效和安全性。方法对2004年3月-2012年6月辽宁省人民医院行PTSMA治疗的4例儿童HOCM患者的临床资料和化学消融结果进行回顾性分析,总结其化学消融术中和术后围术期并发症的发生情况及疗效。结果 4例接受PTSMA治疗的儿童HOCM患者,术后比术前静息左心室流出道压力阶差明显下降,但差异无统计学意义(P>0.05),术后比术前早搏后左心室流出道压力阶差明显降低,差异有统计学意义(P<0.05)。病例1发生Ⅲ度房室传导阻滞,病例2术中发生完全性右束支传导阻滞,均治愈。所有患儿均随访12个月,无严重临床事件发生。结论儿童HOCM患者行PTSMA治疗是有效的。PTSMA可能是治疗儿童HOCM患者的方法之一。

Objective To investigate the effectiveness and safety in pediatric patients （Age≤14 years） with hypertrophic obstructive cardiomyopathy （HOCM） treated by percutanous transluminal septal myocardial ablation （PTSMA）. Methods Retrospectively analyzed the data from four pediatric（age≤14 years） patients with HOCM treated by PTSMA from March 2004 to June 2012, including their clinical data, coronary angiography and the results of PTSMA to evaluate the complication and clinical outcome after PTSMA. Results The left ventricular outlfow tract pressure gradient （LVOTPG） at rest decreased after operation when compared with pre-lablation level （32.0 mm Hg vs 80.0 mm Hg, P＆gt;0.05）. The LVOTPG after premature beat decreased with signiifcant difference after ablation （40.0 mm Hg vs 122.5 mm Hg, P＆lt;0.05）. During opration and hospitalization, 1 patient developed right bundle branch block, and another patient developed complete atrioventricular block, Both patients’ arrhythmia received after temporary pacing and medical treatment. No death and major clinical adverse event recorded after operation and during the 12 months follow up. Conclusions PTSMA was effective and safe for children with HOCM.