经皮室间隔心肌化学消融对肥厚型梗阻性心肌病患者LVOTG及室间隔厚度的影响

Effect of PTSMA on LVOTG and Ventricular Septal Thickness of Patients with HOCM

目的:评价经皮室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:对23例HOCM患者行PTSMA治疗,了解术中靶血管选择情况,观察消融效果,比较手术前及手术后即刻左心室流出道压力阶差(LVOTG)及室间隔厚度,观察手术并发症,术后随访1年,观察LVOTG、室间隔厚度及有无复发。结果:22例HOCM患者间隔支均起源于前降支,1例起源于回旋支;23例患者行PTSMA治疗均成功,即刻消融成功率为100%,术后即刻超声心动图和左心导管测定LVOTG较术前明显下降(P<0.01),1年后随访超声心动图LVOTG及室间隔厚度较术前均明显下降(P<0.01),无死亡病例、传导阻滞及恶性心律失常的发生。结论:PTSMA治疗HOCM近期疗效确切,手术并发症低,能有效降低患者LVOTG,改善患者生活质量。

Objective： To evaluate the short-term efficacy and operative safety of percutaneous transluminal septal myocardial ablation（ PTSMA） in treatment of hypertropic obstructive cardiomyopathy（ HOCM）. Method： 23 patients with HOCM symptoms underwent PTSMA treatment in the hospital.The situation of target vessel selection in operation was evaluated,surgical ablation effect was observed,immediate LVOTG and ventricular septal thickness before and after surgery were compared,and postoperative complications were observed. During 1 year postoperative follow-up,the left ventricular outflow tract pressure gradient（ LVOTG）,interventricular septal thickness and recurrence situation were observed. Results： The septal branches of 22 patients with HOCM originated from anterior descending branch and 1 case originated from the anterior descending branch. The operations of 23 patients undergoing PTSMA treatment was successful. The successful rate of immediate ablation was100%. Compared with preoperative,the immediate postoperative echocardiography and left cardiac catheterization LVOTG was significantly decreased（ P〈 0. 01）. Follow-up after 1 year showed that echocardiography LVOTG and ventricular septal thickness were significantly decreased（ P 〈0. 01）.There was no death case,conduction block and malignant arrhythmia. Conclusion： The short-term curative effect of PTSMA in treatment of HOCM is definite with low occurrence of surgical complica-tions,and can effectively reduce the patient＇s LVOTG and improve the quality of life of patients.