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目的评估室间隔化学消融术(alcohol septal ablation,ASA)治疗肥厚型梗阻性心肌病(hypertrophic obstructive cardiomyopathy,HOCM)患者的临床疗效和安全性。方法 2001年1月至2015年1月行ASA的成年(≥18周岁)HOCM患者44例。术中实时监测静息和激发状态下的左室流出道压力阶差(left ventricular outflow tract gradient,LVOTG),并于术后3 d,1、3、6、12、24个月采用超声心动图检测室间隔厚度、左室射血分数、二尖瓣反流程度、左房和左室容积、估测静息状态下LVOTG值,以及心功能状态、并发症和死亡率情况。结果 44例HOCM患者ASA术后即刻,静息LVOTG由术前(79.9±37.9)mmHg下降至(33.8±30.2)mmHg(P<0.01),激发LVOTG由术前(112.4±43.8)mmHg下降至(36.8±30.0)mmHg(P<0.01)。术后常规给予β受体阻滞剂,术后6个月随访结果显示,舒张末期左房容积由术前(113.8±50.3)mL下降至(97.6±45.7)mL(P<0.01),收缩末期或舒张末期左室容积均有明显增加,左室各节段收缩同步性升高,NYHA心功能分级有明显改善,且未出现严重并发症。结论室间隔化学消融术治疗HOCM的安全性高,疗效显著,结合药物治疗可使患者长期获益。
Objective To evaluate the clinical efficacy and safety of intravenous septal ablation (ASA) in the treatment of patients with hypertrophic obstructive cardiomyopathy (HOCM). Methods From January 2001 to January 2015, 44 adult HOCM patients (≥18 years old) underwent ASA. The left ventricular outflow tract gradient (LVOTG) at rest and in the excited state was monitored in real time. Echocardiography was performed on the 3rd, 3rd, 6th, 12th and 24th month after operation. Interventricular septum thickness, left ventricular ejection fraction, degree of mitral regurgitation, left atrium and left ventricular volume, estimated resting LVOTG values, and cardiac function status, morbidity and mortality. Results In 44 HOCM patients, the mean LVOTG decreased from (79.9 ± 37.9) mmHg to (33.8 ± 30.2) mmHg and the LVOTG decreased from 112.4 ± 43.8 mmHg to 36.8 ± 30.0) mmHg (P <0.01). Postoperative routine administration of beta blockers showed that left atrial volume decreased from (113.8 ± 50.3) mL to (97.6 ± 45.7) mL (P <0.01) preoperatively, and systolic volume Or left ventricular end-diastolic volume were significantly increased, systolic synchronization of each segment of the left ventricle increased, NYHA cardiac function improved significantly, and no serious complications. Conclusion Septal chemical ablation for the treatment of HOCM has high safety and curative effect. Long-term benefit can be obtained by combining with medical treatment.