化学消融术治疗肥厚型梗阻性心肌病的体会

Treatment of hypertrophic obstructive cardiomyopathy with chemo-ablation technique

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±18.32 mmHg降至术后的10.76±9.2mmHg。室间隔厚度由术前25.66±3.17 mm降至术后的14.36±3.08 mm。心肌酶峰值时间为11.2±3.5 h。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,手术是安全的。

Objective To analyze the clinical significance and complication of percutaneous transluminal septal myocardial ablation(PTSMA) to treat the hypertrophic obstructive cardiomyopathy(HOCM). Methods 5 patients with HOCM had accepted PTSMA, to compare LV/LO pressure、septum thick、electrocardiogram before and after operation. Results Left ventricular outflow tract pressure gradient (LVOTPG) droped 10.76±9.2 mmHg from 65.3±18.32 mmHg before operation to 10.76±9.2 mmHg after operation. The septum thicks from 25.66±3.17 mmHg before operation droped to 14.36±3.08 mm, the peak values of enzyme in myocardial appears 11.2±3.5 hours. 3 patients had accelerated ventricular tachycardia of short time, beforelong turned out shorttime Ⅱo AVB. 2 patients had taken right bundce branch block Without anormal Q wave. Conclusion The incidence rate of Arrhythmia was high during the PTSMA, the most appears temporary If the select of case,target vascular was appropriate. The operation is safe.