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目的评估经皮经腔间隔心肌化学消融术(PTSMA)治疗肥厚型梗阻性心肌病(HOCM)近中期疗效。方法 2006年7月至2009年6月,采用Sigwart法对19例(男14例,女5例)症状明显的肥厚型梗阻性心肌病患者进行PTSMA,所有患者均分别于术前、术后1周、术后30天及术后1年接受心脏彩色超声及心电图检查。结果 19例患者手术均成功。术前左心室流出道压差(LVOTPG)均明显高于术后1周、术后30天及术后1年,LVOTPG(92.5±32.4)mmHg vs(36.3±21.6)mmHg、(32.7±24.3)mmHg、(30.1±20.6)mmHg(P<0.05或<0.01)。术前室间隔厚度(IVST)明显大于术后30天及术后1年,IVST(21.7±3.6)mm vs(15.4±4.2)mm、(13.4±2.8)mm(P<0.05或<0.01)。17例患者术后心功能改善、临床症状明显减轻或消失。4例出现完全性右束支传导阻滞,其中1例术后即恢复,1例发生不完全左束支传导阻滞,无Ⅲ度房室传导阻滞发生。结论 PTSMA是HOCM一种安全、有效的治疗手段,IVST及LVOTPG均呈持续性下降。
Objective To evaluate the near-term efficacy of percutaneous transluminal myocardial ablation (PTSMA) in the treatment of hypertrophic obstructive cardiomyopathy (HOCM). Methods From July 2006 to June 2009, 19 patients (14 males and 5 females) with hypertrophic obstructive cardiomyopathy were enrolled in this study. PTSMA was performed in all 19 patients by Sigwart method. All patients were evaluated preoperatively and postoperatively Week, 30 days after surgery and 1 year after surgery underwent color Doppler echocardiography and ECG. Results All the 19 cases were operated successfully. The preoperative left ventricular outflow tract pressure difference (LVOTPG) was significantly higher than that after 1 week, 30 days and 1 year after operation. LVOTPG (92.5 ± 32.4) mmHg vs (36.3 ± 21.6) mmHg, (32.7 ± 24.3) mmHg, (30.1 ± 20.6) mmHg (P <0.05 or <0.01). The preoperative ventricular septal thickness (IVST) was significantly higher than that at 30 days and 1 year after operation. The IVST was (21.7 ± 3.6) mm vs (15.4 ± 4.2) mm and (13.4 ± 2.8) mm respectively (P <0.05 or <0.01). After the operation, heart function improved in 17 patients, clinical symptoms were significantly reduced or disappeared. In 4 cases, there was complete right bundle branch block, of which 1 case recovered after operation, 1 case had incomplete left bundle branch block, and Ⅲ degree atrioventricular block did not occur. Conclusions PTSMA is a safe and effective treatment for HOCM, and both IVST and LVOTPG show a persistent decline.