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...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.展开更多
Objective To evaluate the immediate and follow-up results of percutaneous transluminal septal myocardial ablation (PTSMA) in patients with hypertrophic obstructive cardiomyopathy (HOCM). Methods Fifteen symptomatic...Objective To evaluate the immediate and follow-up results of percutaneous transluminal septal myocardial ablation (PTSMA) in patients with hypertrophic obstructive cardiomyopathy (HOCM). Methods Fifteen symptomatic, drug-refractory patients with HOCM underwent PTSMA procedures with application of a myocardial contrast echocardiography (MCE) intra-procedure. Before and after the procedure, clinical evaluations were obtained in all patients, who were followed up for a mean period of 8.6±3.8 (6-20) months.Results Immediate left ventricular outflow tract gradient (LVOTG) reduction was achieved (77.93±22?mm?Hg vs 14.8±15?mm?Hg, P【0.0001) after the procedure with a mean decrease of 5.75±2.87?mm?Hg of left ventricular end diastolic pressure (P【0.001). Follow up results revealed that ventricular remodelling occurred mainly 1-3 months after the procedure, but without evidence of ventricular dilation and contract dysfunction. Heart function (NYHA) was greatly improved (3.4±0.5 vs 1.1±0.4, P【0.001) and exercise endurance increased. A renewed increase of LVOTG was found in 2 patients during follow-up. Conclusions LVOTG was greatly decreased in HOCM patients undergoing a PTSMA procedure, and their symptoms were greatly improved without cardiac complications during follow-up. Sub-selection and re-opening of target vessels were the causes of renewed increase of LVOTG, and this can be avoided with the accumulation of experience. This is a promising method for the treatment of symptomatic patients with HOCM.展开更多
文摘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.
文摘Objective To evaluate the immediate and follow-up results of percutaneous transluminal septal myocardial ablation (PTSMA) in patients with hypertrophic obstructive cardiomyopathy (HOCM). Methods Fifteen symptomatic, drug-refractory patients with HOCM underwent PTSMA procedures with application of a myocardial contrast echocardiography (MCE) intra-procedure. Before and after the procedure, clinical evaluations were obtained in all patients, who were followed up for a mean period of 8.6±3.8 (6-20) months.Results Immediate left ventricular outflow tract gradient (LVOTG) reduction was achieved (77.93±22?mm?Hg vs 14.8±15?mm?Hg, P【0.0001) after the procedure with a mean decrease of 5.75±2.87?mm?Hg of left ventricular end diastolic pressure (P【0.001). Follow up results revealed that ventricular remodelling occurred mainly 1-3 months after the procedure, but without evidence of ventricular dilation and contract dysfunction. Heart function (NYHA) was greatly improved (3.4±0.5 vs 1.1±0.4, P【0.001) and exercise endurance increased. A renewed increase of LVOTG was found in 2 patients during follow-up. Conclusions LVOTG was greatly decreased in HOCM patients undergoing a PTSMA procedure, and their symptoms were greatly improved without cardiac complications during follow-up. Sub-selection and re-opening of target vessels were the causes of renewed increase of LVOTG, and this can be avoided with the accumulation of experience. This is a promising method for the treatment of symptomatic patients with HOCM.
