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目的 :对梗阻性肥厚型心肌病 (HOCM)行经皮腔内室间隔无水乙醇消融术 (PTSMA) ,并应用多普勒超声心动图进行PTSMA治疗前后系列监测 ,初步探讨PTSMA治疗HOCM的安全性及急性期效果。方法 :对8例伴症状性HOCM患者实行PTSMA。多普勒超声心动图分别于术前及术后监测。术中给予第 1或第 2间隔支注射无水乙醇 1.5～ 5 .0ml,同时行左心导管及心电图系列监测。术后急性期连续观察心肌酶谱、心电图 ,测血压 ,检测左室流出道 (LVOT)压差。结果 :①术后并发症 :在PTSMA后 ,5例 (6 2 .5 % )患者发生了束支传导阻滞 ,其中完全性右束支传导阻滞 4例 (5 0 % ) ,均为暂时性阻滞 ;所有患者在出院时束支传导阻滞均已消失 ,无一例安装起搏器。且无一例发生窦性停搏。术后有 2例 (2 5 % )患者出现了低血压 ;8例 (10 0 % )患者均出现了胸痛 ;有 1例患者术后出现了频发室性期前收缩。②LVOT梗阻情况 (压力差的变化 ) :PTSMA后 ,静息时LVOT压力阶差从术前 (4 1.5 8± 13.37)mmHg(1mmHg =0 .133kPa)下降到 (2 4 .0 5± 12 .98)mmHg(P <0 .0 5 )。术前有 6例患者存在收缩期前向运动 (SAM )现象 ,术后有 2例患者SAM现象消失。③左室收缩、舒张功能和左室肥厚 :术前、后患者在室间隔厚度、左室舒张期内径、左室后壁厚度、左房直径、?
OBJECTIVE: To observe the effect of PTSMA on the safety of HOCM in patients with obstructive hypertrophic cardiomyopathy (HOCM) undergoing percutaneous transluminal absolute ethanol ablation (PTSMA) and monitor the changes before and after PTSMA with Doppler echocardiography And the acute phase effect. Methods: Eight patients with symptomatic HOCM underwent PTSMA. Doppler echocardiography was monitored preoperatively and postoperatively. Intraoperative administration of the first or second interval injection of absolute ethanol 1.5 ~ 5 .0ml, while the left heart catheterization and ECG series monitoring. Myocardial zymogram, electrocardiogram and blood pressure were observed continuously in the acute phase after operation, and the pressure drop of left ventricular outflow tract (LVOT) was measured. Results: ① Postoperative complications: Bipolar artery block occurred in 5 patients (62.5%) after PTSMA, of which 4 cases (50%) had complete right bundle branch block All patients had the bundle branch block disappeared at discharge, and no patient had a pacemaker. And no case of sinus arrest. Hypotension occurred in 2 patients (25%) after operation; chest pain occurred in 8 patients (100%); and one patient had frequent premature ventricular contractions after operation. LVOT obstruction (changes in pressure difference): After PTSMA, LVOT pressure gradient at rest decreased from (4 1.58 ± 13.37) mmHg (1mmHg = 0.133kPa) to (24.5 ± 12.98% ) mmHg (P <0. 05). Preoperative 6 patients had systolic anterior motion (SAM) phenomenon, 2 patients after the disappearance of the SAM phenomenon. Left ventricular systolic and diastolic function and left ventricular hypertrophy: preoperative and postoperative patients in the thickness of the interventricular septum, left ventricular diastolic diameter, left ventricular posterior wall thickness, left atrial diameter,