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[Abstract] Objective To evaluate percutaneous transluminal septal myocardial ablation (PTSMA) treatment of hypertrophic obstructive cardiomyopathy (HOCM) in the medium-term efficacy. Method in August 1998 on October -2001 HOCM patients were enrolled in 119 lines PTSMA, of which 34 cases were followed up nearly 2 (2 0.5) years. In the six months before and after ablation (5-7 months) to 2 years line echocardiography ventricular septal thickness and left ventricular outflow tract width. Results 34 patients were followed up after 2 years the average septal thickness (16.1 4.8) mm, [pre (23.9 6.0) mm, after six months (18.8 4.1) mm], the average left ventricular outflow tract width (15.1 5 .3) mm, before operation [(6.6 2.3) mm, after six months (12.1 3.3) mm]. Conclusion PTSMA can significantly reduce septal thickness, increased left ventricular outflow tract width, increasing effect with time.
[Key words] cardiomyopathy, hypertrophic; by catheter intervention; absolute alcohol
The efficacy of percutaneous transluminal septal myocardial ablation on hypertrophic obstructive cardiomyopathy, a long-term follow up result ZHANG Ming, LI Zhan-quan, JIN Yuan-zhe, et al. Liaoning Provincial Hospital, Liaoning InterventioraJ Cardiology Centre, Shenyang 110016, China
[Abstract] Objective To evaluate the long-term efficacy of percutaneous transluminal septal myocardial ablation (PTSMA) on hypertrophic obstructive cardiomyopathy (HOCM). Methods From Auplst l998 to


October 2001,119 patients with HOCM underwent PTSMA by Sigwart method. Thirty four patients among them were follow-up2 (2 0.5) years. The tickness of septal myocardium and width of left ventricular outflow-tract (LVOT) were measured before and 6 months and 2 years after PTSMA. Results The thickness of the septal myocardium reduced from (23.9 6.0) mm before ablation to (18.8 Soil 4.1) mm at 6 (5-7) month after PTSMA, and (16.1 Soil 4.8) mm at 2 years after PTSMA. The width of LVOT expanded from (6.6 soil 2.3) mm before ablation to (12.1 Soil 3.2) mm at 6 month and (15.1 5.3) mm at 2 years after PTSMA. Conclusion Two years follow-up data showed that PTSMA could significantly reduce the thickness of septal myocardium and expand the width of LVOT.
[Key words] Cardiomypathy, hypertrophic; Cartheter intervenfional therapy; Alcoho1
Interval percutaneous ablation (percutaneous transluminal septal myocardial ablation, PTSMA) treatment of hypertrophic obstructive cardiomyopathy (hypertrophic obstractive cardiomypathy, HOCM) is involved in the treatment of the disease in recent years, a new field, this study of 34 cases 2 of patients.August 1998 -2001 period echocardiography in 10 patients underwent diagnostic HOCMll9 PTSMA, of which 34 cases were followed up for 2 years, 20 males and 14 females, aged 12-46 (31.6 8.4) years, mean history of 4.2 years. NYHA. Cardiac function assessed as 3.2 0. Candidate criteria: (1) significant clinical symptoms (clear syncope, history of angina or heart failure); (2) Ultrasound diagnosis of left ventricular outflow tract (LVOT) width of the occurrence of atrioventricular block, you can moderate increase the amount of alcohol injected. Injection of alcohol should not be too much thrust, the whole process should be carried out under X-ray, to prevent filling the balloon pop-up the alcohol into the left anterior descending artery. Patients should be closely observed while heart rate and rhythm changes, such as the severity of chest pain, occurred during injection of atrioventricular block or severe ventricular arrhythmias should be suspended injection. In order to reduce chest pain, often before the injection of alcohol, intravenous injection of morphine. Surgical ablation as LVOTPG decline 50%. (4) The recommended method of measuring LVOTPG: catheter with side holes (at right coronary angiography catheter or a multipurpose catheter) in the continuous pressure measurement between the left ventricle and aorta to obtain a continuous pressure curve, measurement, LVOTPG; by-side hole catheter placed in aortic valve and the other set of people left ventricular pigtail catheter, the simultaneous measurement of aortic root and left ventricular cavity pressure curve, in the absence of valvular disease, its pressure is the LVOTP. (5) Determination of stress pressure: stimulation drugs: dobutamine 5-20 ~ g · kg-1 · min-1, or isoproterenol intravenously, the heart rate increased 30%; premature stimulation, fixed couplets interval, such as a joint between the law of 370ms, or determined under the heart of Union between law; tile s action.
2. Echocardiography techniques: use of diagnostic ultrasound equipment for the HPSONOS2500, the patient left lateral position (45 ), the size of the heart chamber, IVS and left ventricular posterior wall thickness measurements, especially outside the IVS thickness and LVOT LVOT To accurately measure the width of the pulsed Doppler in the apical two-chamber plane between the measured LVOT and left ventricular pressure gradient, so that the beam and minimize the angle between blood flow (20 patients with sinus bradycardia (58.8%), transient junctional rhythm in 8 cases (23.5%), ventricular premature beat in 13 cases (38.2%), ventricular tachycardia in 2 cases (5.8%).
Discussion
HOCM is a primary hypertrophic cardiomyopathy in a special type of cardiomyopathy, hypertrophic cardiomyopathy because of left ventricular outflow tract obstruction caused by its name. Subsequent studies have found, HOCM showed cardiac and hemodynamic load IVS hypertrophy out of proportion, can not affect septal myocardial hypertrophy LVOT, do not form LVOTPG (about 3 / 4), can also affect the LVOT, the formation of LVOTPG (about 1 / 4), which is the HOCM. Except HOCM valve disease must be diagnosed with hypertension and other diseases caused by left ventricular overload.
HOCM variety of clinical manifestations, severity, course, outcome, prognosis varies. Patients may be asymptomatic, sustained in a steady state or in the 5 to 10 years to deteriorate rapidly. Most patients can be maintained for about 10 years of stability, can worsen some symptoms and some may even be improved in clinical symptoms. 3% annual mortality of adult children of about 6%.
Prevention and treatment principles: to avoid any increase in LVOT transvalvular pressure behavior, ie to avoid reducing Huixin blood, to avoid low blood volume, blood pressure, prevent arrhythmia, avoid strenuous exercise.
Treatment includes: drug therapy, non-drug treatment, which includes surgery (all except hypertrophic open interval surgery, heart transplantation PTSMA) and interventional treatment of [dual-chamber pacemaker (DDD) treatment and PTSMA]. Surgical treatment of ventricular hypertrophy is mainly cut everything except surgery, adapted to medical therapy, symptoms, left ventricular outflow tract pressure 50mmHg at rest or after stress pressure 100 mm Hg, those with extremely thick interval . Surgery can significantly reduce the symptoms of pressure and mitral regurgitation; This surgery can also mitral valve replacement. For a relatively thin ventricular septum (large trauma, and poor patients.
DDD treatment: the mechanism of apical and basal cardiac contraction is not synchronous, so the level of the LVOT in systolic mitral valve widened. That is caused by right ventricular apical pacing abnormal IVS motion (systolic chamber moves to the right) to reduce the outflow tract obstruction [6]. Currently there are many centers in the world of clinical observation, including randomized double-blind and AAI (atrial pacing) in control experiments and up to 5 years of follow-up results. There is no evidence that the pacemaker can reduce the risk of sudden death or change the clinical course of patients. Nishimura et al [7] recently conducted a randomized, double-blind, crossover controlled study, the results of treatment of 21 patients with HOCM in patients with DDD 19 cases, of which 63% LVOT pressure decrease, symptom improvement, 31% of patients with symptoms of no improvement, 5 % of patients with symptoms have worsened. DDD pacing in patients with recent randomized double-blind, crossover trial (M-PATHY) confirmed that more than 65 years of age except in the age group showing efficacy of DDD pacing in patients, other patients with the same efficacy and placebo, and subjective symptoms of long-term improvement is not accompanied by objective indicators improved. 48 people LVOTG 57% decrease, no change accounted for 43%. Therefore, we believe that DDD pacing can not be used as medical therapy, the symptoms of patients with severe HOCM treatment of choice [8].
PTSMA appeared in recent years, another method of treatment of HOCM, the British doctor Sigwart [9] in 1995 and the first clinical application. Sigwart reports 3 cases of severe clinical symptoms of hypertrophic obstructive cardiomyopathy, the use of ethanol into the myocardium of IVS interval supply vessel, resulting in artificial "septal myocardial infarction", relieving LVOT obstruction, after 6 months to 1 year of follow-up, the patient's heart function was improved, clinical symptoms, and surgical excision of the IVS hypertrophy obtained the same effect.
50% of the 129 cases (54%), reduced by 20% -49% (13%), unchanged in 8 patients (3%). LVOTPG from preoperative (72 soil 35) mmHg decreased to surgery (20 soil 22) mm Hg. Which 197 patients were followed up 3 months, cardiac function improved from 2.8 soil 0.5 soil increased to 1.3 after 0.9 (p


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