经皮室间隔心肌化学消融术治疗肥厚型梗阻性心肌病

Observation of therapeutic effects of percutanous transluminal septal myocardial ablation for hypertrophic obstructive cardiomyopathy

目的 :探讨肥厚型梗阻性心肌病经皮腔内室间隔消融术的临床意义及其并发症。方法 :5例肥厚型梗阻性心肌病患者完成经皮腔内室间隔消融术 ,观察比较术前术后数字指标及心电图变化。结果 :左室流出道压力阶差由术前65 .10± 18.3 2mmHg降至术后的 10 .76± 9.2mmHg。室间隔厚度由术前 ( 2 5 .66± 3 .17)mm降至术后 ( 14 .3 6± 3 .0 8)mm。心肌酶峰值时间为 11.2± 3 .5h ,3例出现短阵加速性室速 ,后转为短暂Ⅲ度房室传导阻滞 ,2例为右束支传导阻滞 ,无异常Q波发生。结论 :经皮腔内室间隔消融术致心律失常发生率高 ,多为一过性 ,只要病例选择恰当 ,靶血管选择正确 。

Objective To analyse the clinical significance and complication of percutanous transluminal septal myocardial ablation (PTSMA) in the treatment of hypertrophic obstructive cardiomyopathy(HOCM).Methods Five patients of HOCM accepted PTSMA and compared their LV/LO pressure,septum thick and electrocardiogram before and after operation.Results Left ventricular outflow tract pressure gradient (LVOTPG) dropped from 65.3±18.32mmHg before operation to 10.76 ±9.2mmHg,and septum thicks from 25.66±3.17mm before operation to 14.36±3.08mm.The peak values of enzyme in myocardial appeared 11.2±3.5h.Three patients had transient accelerate ventricular tachycarda and turned to transient Ⅲ° atrioventricular block.Two patients had right bundle branch block,without abnormal Q wave.Conclusion Arrhythmias occurrence is high in the PTSMA,most of which are temporary.The operation will be safe when the case and target vessel are chosen properly.;