经冠状动脉消融肥厚心肌和外科治疗肥厚型梗阻性心肌病

Transcoronary ablation of septal hypertrophy and surgical treatment of hypertrophic obstructive cardiomyopathy

目的 回顾性分析外科和经冠状动脉消融肥厚间隔心肌 (transcoronaryablationofseptalhypertrophy ,TASH)治疗肥厚型梗阻性心肌病 (hypertrophicobstructivecardiomyopathy ,HOCM )近、中期 (3～ 2 4个月 )的疗效和安全性。方法 54例HOCM患者在我院分别接受外科 (11例 )或TASH(43例 )治疗。治疗前、后评价患者的主观症状和客观检查系列结果。结果 外科和TASH后即刻左室流出道压力阶差 (PGLVOT)下降显著 [外科 (75± 48)mmHg(1mmHg =0 13 3kPa) ,TASH(56± 2 8)mmHg] ,但下降率差异无显著意义 (76 8%比 74 0 % ,P >0 0 5)。6例PGLVOT 反弹 ,TASH后 5例 ,出现在术后 3～ 6个月 ,外科后 1例 ,出现在术后 2 4个月。术后患者主观症状改善显著 ,但改善程度二组患者差别不显著。围术期死亡 2例 ,分别死于脑出血 (外科 )和严重心动过缓 (TASH ,拒绝安装起搏器 )。结论 TASH治疗HOCM的近、中期效果与外科相似 ,与外科相比 ,其并发症也是可以接受的 。

Objective The safety and efficacy of surgical and nonsurgical transcoronary ablation of septal hypertrophy (TASH) treatment of hypertrophic obstructive cardiomyopathy (HOCM) were evaluated retrospectively in short-term, mid-term (3-24 months) follow-up Methods Among 54 patients with HOCM, 11 treated by surgery, 43 by TASH The serial changes of the patients′ subjective symptoms and objective examinations were evaluated before and after the treatment procedures Results Both TASH and surgery could immediately reduce left ventricular outflow pressure gradient(PG LVOT ) significantly (with mean decrease of 75±48 mm Hg for surgery, P<0 000 1, and 56±28 mm Hg for TASH, P<0 000 1),but the decreased rates between the two methods had no significant difference (74 0% vs 76 8%, P>0 05) Rebound of PG LVOT were found in 6 patients after these procedures, 5 treated by TASH, which occurred at 3-6 months, and 1 surgery occurred after 24 months The subjective symptoms showed substantial improvement in most patients, and the scores for evaluating the patients′ symptoms did not show the difference between the two methods during the follow-up Two patients died in perioprocedures, one for cerebral hemorrhage (surgery) and the other for advanced bradycardia (TASH) Conclusion The safety and efficacy of TASH for HOCM were similar to those obtained by surgical treatment in short and mid-term follow-up Long term prognosis should be further evaluated.