肥厚梗阻型心肌病化学消融术中、术后严重并发症及防治

Prevention and Treatment of Complications of Percutaneous Transluminal Septal Myocardial Ablation in Hypertrophic Obstructive Cardiomyopathy

目的 :报告经皮室间隔心肌化学消融术治疗肥厚梗阻型心肌病术中、术后出现的严重并发症 ,探讨其原因和机制 ,总结经验、教训 ,以期减少其发生。方法 :2 0例肥厚梗阻型心肌病患者用Sigwart法行化学消融术 ,观察术中、术后出现的严重并发症。结果 :2 0例患者中合并下壁急性心肌梗死 2例 ,前壁心肌梗死 1例 ;术后心室颤动 1例 ;永久性Ⅲ度房室传导阻滞 1例 ;术后严重血流动力学障碍 1例 ;术中左冠状动脉回旋支栓塞 1例。结论 :肥厚梗阻型心肌病化学消融术中及术后可发生多种严重并发症 ,明确靶血管与消融心肌之间的关系、选择恰当的一支或多支间隔支动脉行化学消融 。

Objective: To reduce the serious complications of percutaneous transluminal septal myocardial ablation (PTSMA) in patients with hypertrophic obstructive cardiomyopathy (HOCM) Methods: Twenty patients with HOCM underwent PTSMA with Sigwart method The complications were observed during and after ablation Results: Out of the 20 patients inferior wall acute myocardial infarction was found in 2,anterior wall acute myocardial infarction in 1,ventricular fibrillation in 1,permanent complete atrio ventricular block in 1,severe hemodynamic obstruction in 1 and embolism in circumflex branch of left coronary artery in 1 Conclusion: Many complications may occur during and after PTSMA The key to reduce complications is to select one or multiple appropriate septal branch arteries for chemical ablation