Background： Percutaneous transluminal septal myocardial ablation （PTSMA） and modified Morrow septal myectomy （MMSM） are two invasive strategies used to relieve obstruction in patients with hypertrophic cardiomyop...Background： Percutaneous transluminal septal myocardial ablation （PTSMA） and modified Morrow septal myectomy （MMSM） are two invasive strategies used to relieve obstruction in patients with hypertrophic cardiomyopathy （HCM）. This study aimed to determine the clinical outcome of these two strategies. Methods： From January 2011 to January 2015,226 patients with HCM were treated, 68 by PTSMA and 158 by MMSM. Both ultrasonic cardiograms and heart functional class were recorded before, alter operations and in the follow-up. Categorical variables were compared using Chi-square or Fisher＇s exact tests. Quantitative variables were compared using the paired samples t-test. Results： lnterventricular septal thickness was significantly reduced in both groups （21.27 ± 4.43 mm vs. 18.72 ±4.13 mm for PTSMA, t = 3.469, P 〈 0.001, and 21.83± 5.03 mm vs. 16.57 ± 3.95 mm for MMSM, t = 10.349, P 〈 0.001, respectively）. The left ventricular outflow tract （LVOT） pressure gradient （PG） significantly decreased after the operations in two groups （70.30 ± 44.79 mmHg vs. 39.78 ±22.07 mmHg for PTSMA, t = 5.041, P 〈 0.001, and 74.58 ± 45.52 mmHg vs. 13.95 ± 9.94 mmHg for MMSM, t = 16.357, P 〈 0.001, respectively）. Seven patients （10.29%） in the PTSMA group required a repeat operation in the follow-up. Eight （11.76%） patients were evaluated for New York I-lean Association （NYHA） Ill/IV in the PTSMA group, which was significantly more than the five （3.16%） in the same NYHA classes lbr the MMSM group at follow-up. Less than 15% of patients in the PTSMA group and none of the patients in the MMSM group complained of chest pain during follow-up. Conclusions： Both strategies can not only relieve LVOT PG but also improve heart function in patients with HCM. However, MMSM might provide a more reliable reduction in gradients compared to PTSMA.展开更多
Hypertrophic obstructive cardiomyopathy （HOCM） is a genetic disorder characterized by severe asymmetric hypertrophy of the interventricular septum （IVS） in the absence of any other systemic or cardiac diseases. Th...Hypertrophic obstructive cardiomyopathy （HOCM） is a genetic disorder characterized by severe asymmetric hypertrophy of the interventricular septum （IVS） in the absence of any other systemic or cardiac diseases. The predominant abnormal haemodynamics are caused by increased left ventricular outflow tract pressure gradient （LVOTG） and abnormal systolic anterior motion of mitral valve.展开更多
目的:总结70岁以上肥厚性梗阻型心肌病(HOCM)患者行经皮室间隔心肌化学消融术(PTSMA)治疗的并发症发生情况及近期疗效,探讨70岁以上HOCM患者行PTSMA的利与弊。方法:对1998-07至2010-07我院行PTSMA治疗的9例70岁以上HOCM患者的临床资料...目的:总结70岁以上肥厚性梗阻型心肌病(HOCM)患者行经皮室间隔心肌化学消融术(PTSMA)治疗的并发症发生情况及近期疗效,探讨70岁以上HOCM患者行PTSMA的利与弊。方法:对1998-07至2010-07我院行PTSMA治疗的9例70岁以上HOCM患者的临床资料和化学消融结果进行回顾性分析,总结其化学消融术中和术后围术期并发症的发生情况及近期疗效。结果:9例70岁以上HOCM患者中共8例接受PTSMA治疗,术后静息及早搏后左心室流出道压力阶差明显降低(13.29±16.60 vs 77.71±45.51,P=0.006;42.25±21.98 vs 113.50±38.46,P=0.04),左心室射血分数较术前略有下降,但差异无统计学意义(0.60±0.05 vs 0.62±0.05,P=0.053)。术中发生完全性右束支传导阻滞3例,Ⅲ度房室传导阻滞1例,急性心包填塞、死亡1例,急性左心衰竭、死亡1例。结论:70岁以上HOCM患者行PTSMA治疗是有效的,但围术期并发症发生率较高,死亡率较高,因此70岁以上HOCM患者行PTSMA弊大于利,应谨慎施行。展开更多
目的:分析肥厚型梗阻性心肌病(HOCM)患者经皮室间隔心肌消融术(PTSMA)后并发症情况。方法:回顾性分析2000-08至2017-04在我院住院拟行PTSMA的357例HOCM患者临床资料及术后每半年1次的随访资料。随访内容包括死亡及心包填塞、房室阻滞、...目的:分析肥厚型梗阻性心肌病(HOCM)患者经皮室间隔心肌消融术(PTSMA)后并发症情况。方法:回顾性分析2000-08至2017-04在我院住院拟行PTSMA的357例HOCM患者临床资料及术后每半年1次的随访资料。随访内容包括死亡及心包填塞、房室阻滞、穿刺动脉通路损伤和下肢静脉血栓等并发症。结果:352例(98.6%)患者成功接受PTSMA,其中320例(90.9%)患者术中即刻获得成功,术前左心室流出道压差为(97.9±36.9)mm Hg(1 mm Hg=0.133 k Pa),术后即刻为(25.5±18.1)mm Hg。围术期发生并发症包括:心包填塞4例(1.1%),术中发生一过性三度房室阻滞127例(36.1%),严重恶性心律失常18例(5.1%),交通支开放14例(4.0%),下肢静脉血栓5例(1.4%),穿刺动脉通路损伤6例(1.7%)。围术期死亡4例(1.1%),包括交通支开放1例、心脏破裂1例、腹膜后血肿1例和药物性肝衰竭继发多脏器衰竭1例。长期随访结果:平均随访(6.2±3.8)年,共有6例患者死亡,其中3例为猝死,1例因心房颤动脑栓塞死亡,1例死于脑出血,1例因直肠癌死亡。结论:PTSMA对有解剖学适应证的HOCM患者疗效确切,在术中精细操作、术后严密监护的情况下,严重并发症相对不多,安全性较好。展开更多
基金This work was supported by grants from the National Natural Science Foundation of China （No. 81370328, and No. 81770371）.
文摘Background： Percutaneous transluminal septal myocardial ablation （PTSMA） and modified Morrow septal myectomy （MMSM） are two invasive strategies used to relieve obstruction in patients with hypertrophic cardiomyopathy （HCM）. This study aimed to determine the clinical outcome of these two strategies. Methods： From January 2011 to January 2015,226 patients with HCM were treated, 68 by PTSMA and 158 by MMSM. Both ultrasonic cardiograms and heart functional class were recorded before, alter operations and in the follow-up. Categorical variables were compared using Chi-square or Fisher＇s exact tests. Quantitative variables were compared using the paired samples t-test. Results： lnterventricular septal thickness was significantly reduced in both groups （21.27 ± 4.43 mm vs. 18.72 ±4.13 mm for PTSMA, t = 3.469, P 〈 0.001, and 21.83± 5.03 mm vs. 16.57 ± 3.95 mm for MMSM, t = 10.349, P 〈 0.001, respectively）. The left ventricular outflow tract （LVOT） pressure gradient （PG） significantly decreased after the operations in two groups （70.30 ± 44.79 mmHg vs. 39.78 ±22.07 mmHg for PTSMA, t = 5.041, P 〈 0.001, and 74.58 ± 45.52 mmHg vs. 13.95 ± 9.94 mmHg for MMSM, t = 16.357, P 〈 0.001, respectively）. Seven patients （10.29%） in the PTSMA group required a repeat operation in the follow-up. Eight （11.76%） patients were evaluated for New York I-lean Association （NYHA） Ill/IV in the PTSMA group, which was significantly more than the five （3.16%） in the same NYHA classes lbr the MMSM group at follow-up. Less than 15% of patients in the PTSMA group and none of the patients in the MMSM group complained of chest pain during follow-up. Conclusions： Both strategies can not only relieve LVOT PG but also improve heart function in patients with HCM. However, MMSM might provide a more reliable reduction in gradients compared to PTSMA.
基金This study was supported by a grant from Nanjing Sci-Tech Bureau (No. 2002H30).
文摘Hypertrophic obstructive cardiomyopathy （HOCM） is a genetic disorder characterized by severe asymmetric hypertrophy of the interventricular septum （IVS） in the absence of any other systemic or cardiac diseases. The predominant abnormal haemodynamics are caused by increased left ventricular outflow tract pressure gradient （LVOTG） and abnormal systolic anterior motion of mitral valve.
文摘目的:总结70岁以上肥厚性梗阻型心肌病(HOCM)患者行经皮室间隔心肌化学消融术(PTSMA)治疗的并发症发生情况及近期疗效,探讨70岁以上HOCM患者行PTSMA的利与弊。方法:对1998-07至2010-07我院行PTSMA治疗的9例70岁以上HOCM患者的临床资料和化学消融结果进行回顾性分析,总结其化学消融术中和术后围术期并发症的发生情况及近期疗效。结果:9例70岁以上HOCM患者中共8例接受PTSMA治疗,术后静息及早搏后左心室流出道压力阶差明显降低(13.29±16.60 vs 77.71±45.51,P=0.006;42.25±21.98 vs 113.50±38.46,P=0.04),左心室射血分数较术前略有下降,但差异无统计学意义(0.60±0.05 vs 0.62±0.05,P=0.053)。术中发生完全性右束支传导阻滞3例,Ⅲ度房室传导阻滞1例,急性心包填塞、死亡1例,急性左心衰竭、死亡1例。结论:70岁以上HOCM患者行PTSMA治疗是有效的,但围术期并发症发生率较高,死亡率较高,因此70岁以上HOCM患者行PTSMA弊大于利,应谨慎施行。
文摘目的:分析肥厚型梗阻性心肌病(HOCM)患者经皮室间隔心肌消融术(PTSMA)后并发症情况。方法:回顾性分析2000-08至2017-04在我院住院拟行PTSMA的357例HOCM患者临床资料及术后每半年1次的随访资料。随访内容包括死亡及心包填塞、房室阻滞、穿刺动脉通路损伤和下肢静脉血栓等并发症。结果:352例(98.6%)患者成功接受PTSMA,其中320例(90.9%)患者术中即刻获得成功,术前左心室流出道压差为(97.9±36.9)mm Hg(1 mm Hg=0.133 k Pa),术后即刻为(25.5±18.1)mm Hg。围术期发生并发症包括:心包填塞4例(1.1%),术中发生一过性三度房室阻滞127例(36.1%),严重恶性心律失常18例(5.1%),交通支开放14例(4.0%),下肢静脉血栓5例(1.4%),穿刺动脉通路损伤6例(1.7%)。围术期死亡4例(1.1%),包括交通支开放1例、心脏破裂1例、腹膜后血肿1例和药物性肝衰竭继发多脏器衰竭1例。长期随访结果:平均随访(6.2±3.8)年,共有6例患者死亡,其中3例为猝死,1例因心房颤动脑栓塞死亡,1例死于脑出血,1例因直肠癌死亡。结论:PTSMA对有解剖学适应证的HOCM患者疗效确切,在术中精细操作、术后严密监护的情况下,严重并发症相对不多,安全性较好。
