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目的:探讨经皮导管室间隔心肌化学消融术(PTSMA)治疗肥厚型梗阻性心肌病(HOCM)方法及近期疗效。方法:11例HOCM患者,经心脏超声及导管测压证实存在左室流出道压力阶差(LVOTG),选择靶间隔支注入无水乙醇消融后记录LVOTG变化,出院时及出院后1个月复查超声心动图。结果:11例患者中消融第1间隔支者9例,消融第2间隔支者1例,同时消融第1、第2间隔支者1例;术后即刻导管测量LVOTG较术前明显下降[(90.40±41.95)∶(52.90±34.12)mmHg(1 mmHg=0.133 kPa),P<0.01]。11例中1例术后4 h死亡,1例术后第5天置入永久双腔起搏器,其余9例度过围术期并出院随访。10例存活者出院时与术前相比,LVOTG和二尖瓣收缩期前移(SAM)幅度较术前明显改善[(44.56±28.87)∶(82.98±36.46)mmHg,(2.3±1.06)∶(4.1±1.37)mm,P<0.01)];术后1个月超声测量LVOTG、室间隔厚度、左室流出道内径和SAM幅度分别为:(40.43±19.27)mmHg、(18.6.1±1.17)mm、(15.5±1.08)mm和(0.5±0.53)mm,均较术前及出院时明显改善(P<0.01)。结论:PTSMA治疗HOCM有一定疗效,但属于破坏性手术,需严格进行手术风险控制。
Objective: To investigate the efficacy and safety of percutaneous transcatheter arterial septal myocardial chemical ablation (PTSMA) in the treatment of hypertrophic obstructive cardiomyopathy (HOCM). Methods: Eleven HOCM patients underwent cardiac ultrasonography and catheter manometry to confirm the presence of left ventricular outflow tract pressure gradient (LVOTG). Target perfusion was recorded after ablation of absolute ethanol and LVOTG changes were recorded. At discharge and 1 month after discharge, Echocardiography. Results: In 11 patients, there were 9 cases of ablation of the first spacer, 1 case of ablation of the second spacer, 1 case of the first and second spacer ablation, and the immediate postoperative catheterization of LVOTG was significantly decreased 90.40 ± 41.95): (52.90 ± 34.12) mmHg (1 mmHg = 0.133 kPa), P <0.01]. One patient in 11 cases died at 4 hours after operation. One patient had permanent dual chamber pacemaker on the 5th day after operation. The remaining 9 patients underwent perioperative period and were discharged from hospital. Compared with the preoperative, the survival rate of LVOTG and mitral valve systole (SAM) in 10 survivors was significantly lower than that before operation [(44.56 ± 28.87) vs (82.98 ± 36.46) mmHg, (2.3 ± 1.06) (4.1 ± 1.37) mm, P <0.01). LVOTG, ventricular septal thickness, left ventricular outflow tract diameter and SAM amplitude were (40.43 ± 19.27) mmHg and (18.6 ± 1.17) ) mm, (15.5 ± 1.08) mm and (0.5 ± 0.53) mm, respectively, compared with that before operation and at discharge (P <0.01). Conclusion: PTSMA has a certain curative effect in the treatment of HOCM. However, it is a destructive surgery and needs strict control of surgical risk.