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目的:评价经皮室间隔心肌消融术(PTSMA)治疗84例肥厚型梗阻性心肌病的疗效和安全性。方法:自1999年9月至2010年7月采用Sigwart法为84例有症状的肥厚型梗阻性心肌病(HOCM)患者行PTSMA治疗。在心脏超声的应用、消融操作、压力监测、疗效评价以及术后处理等方面做了一些改进。结果:每例患者共用无水乙醇0.6~9ml,分别消融1~5支前间隔支血管,在心肌声学造影(MCE)指导下大部分病例行室间隔基底部全层心肌的多间隔支消融。术后即刻导管测左室流出道压差84例均较术前下降>50%。随访8周到11年,79例患者超声指标和临床症状消失或较术前改善;3例患者随访期间症状复发;2例随访期间开始半年和4年症状和超声指标进行性改善,1例术后1年半后死于扩张型心肌病,1例术后4年死于脑中风。术中21例患者出现一过性Ⅱ度以上的房室传导阻滞,14例患者出现一过性短暂室性心动过速,5例出现前间隔心肌梗死心电图改变,其中1例伴有下壁心肌梗死心电图改变。本组患者无围术期死亡和严重并发症发生。结论:MCE指导下经皮腔内室间隔多间隔支心肌消融术治疗HOCM疗效满意,安全性好。
Objective: To evaluate the efficacy and safety of percutaneous transluminal myocardial ablation (PTSMA) in the treatment of 84 patients with hypertrophic obstructive cardiomyopathy. METHODS: From September 1999 to July 2010, 84 patients with symptomatic hypertrophic obstructive cardiomyopathy (HOCM) were treated with PTSMA using the Sigwart method. Some improvements have been made in the application of echocardiography, ablation procedures, stress monitoring, curative evaluation and postoperative treatment. Results: In each patient, 0.6 to 9 ml of absolute ethanol was ablated, and 1 to 5 anterior segmental vessels were ablated. Under the guidance of myocardial contrast echocardiography (MCE), most patients underwent multi-septal ablation of the whole floor of the basal lamina. Immediately after catheterization 84 cases of left ventricular outflow tract pressure drop more than preoperative> 50%. The follow-up of 8 weeks to 11 years, 79 patients with ultrasound index and clinical symptoms disappeared or improved compared with the preoperative; 3 patients with symptoms recurrence during follow-up; 2 cases of follow-up period of six months and 4 years symptoms and ultrasound improved significantly, 1 case 1 year and a half died of dilated cardiomyopathy, and 1 died of stroke after 4 years. Intraoperative 21 patients had a transient degree of second degree atrioventricular block, 14 patients had transient transient ventricular tachycardia, 5 patients had pre-septal myocardial infarction ECG changes, including 1 case with the next wall Myocardial infarction ECG changes. This group of patients without perioperative deaths and serious complications. Conclusion: MCE-guided percutaneous transluminal septal multi-septal myocardial ablation for the treatment of HOCM is effective and safe.