摘要
OBJECTIVE: To assess the complications of percutaneous tansluminal septal myocardial ablation (PTSMA) for the treatment of hypertrophic obstructive cardiomyopathy (HOCM). METHODS: Seventy-two patients with symptomatic left ventricular outflow tract obstruction were diagnosed by echocardiography or catheterization procedures. Absolute ethanol was injected into the target coronary artery branch (branches) for septal myocardial ablation. Documented complications were recorded. RESULTS: Sixty-nine patients had severe chest pain, 19 developed different degrees of heart block during the periprocedural period, but only one developed a complete AV block, requiring permanent pace-maker implantation. Temporary right bundle branch block occurred in 50% of patients and permanent block occurred in 38.9% of patients. Acute inferior myocardial infarction occurred in six patients (8.3%) and acute anterior myocardial infarction occurred in one patient. During two-year follow-up of 24 cases, there were no deaths. All patients had improvement in heart function and none experienced heart failure. CONCLUSION: The most common complication of PTSMA is right bundle branch block. The most significant complication of the procedure is heart block. PTSMA is a good technical, non-surgical treatment for HOCM.
目的 评价非手术疗法 ,即经皮穿刺间隔心肌消融术治疗肥厚型梗阻性心肌病 (HOCM)并发症。方法 72名有流出道梗阻症状的病人 ,术前经心脏超声心动图明确诊断。病人被施行导管手术 ,以无水酒精注入靶血管内。观察并发症并分析其可能的原因结果 在注入酒精时 ,6 9名病人发生严重胸痛 ,在手术及术后围手术期间 ,19名病人有不同程度的心脏传导阻滞 ,其中一名病人呈现永久性完全房室传导阻滞 ,需植入永久性起搏器。束枝传导阻滞在本研究中非常常见 ,暂时性右束枝传导阻滞占 5 0 % ,永久性右束枝传导阻滞占 38 9%。 6例 (8 3% )发生急性下壁心肌梗死 ,一例(1 4 % )发生急性前壁心肌梗死。在超过二年的长期随访组中 ,2 4例病人无一例死亡 ,至目前为止 ,该组病人的心功能没有进行性恶化。在本研究中 ,无论长期及近期观察 ,均无死亡发生。结论 心肌消融治疗肥厚型梗阻性心肌病最普遍的并发症是右束枝传导阻滞。最重要的并发症是心脏传导阻滞。
