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經皮穿腔中膈心肌血管栓塞術對阻塞性肥厚心肌症之應用

Percutaneous Transluminal Septal Myocardial Ablation in Hypertrophic Obstructive Cardiomyopathy

摘要


Hypertrophic obstructive cardiomyopathy (HOCM) might induce left ventricular outflow tract obstruction to get pressure gradient seen in approximately 25% of cases with hypertrophic cardiomyopathy; HCM. Medical therapy was ineffective in about 5% patients. This patient group received septal myectomy operation and had heart failure improvement before 1980 era. Sigwart developed percutaneous transluminal septal myocardial ablation (PTSMA) techniques for symptoms improvement in 1995. By injecting 0.8-1.5ml 99.5% alcohol into the treated vessel to ablate septal myocardium; reduced left ventricular out flow tract pressure. A 50% pressure gradient reduction was the therapeutic goal of this technique. There were 11 consecutive cases received PTSMA between April, 2001 and January, 2008. At our institute, the mean age was 58.7 years old (±10.9). Two cases developed atrioventricle block during this procedure. Mean pressure gradient reduced from 113.3mmHg (±48.2mmHg) to 26.9mmHg (±13.6mmHg) after this procedure (p<0.001). Thickness of septal myocardium decreased from 21.4mm to 18.3mm after treatment (p<0.05). Mean Creatine kinase was 1064.4U/L (±468.4U/L) and Creatine kinase isoenzymes-MB was 162.9U/L (±101.6 U/L) after treatment. Clinical application of PTSMA was over a decade, but it was still controversy on long term result. So far, there were more than 3,000 cases reported in the worldwide. PTSMA was an alternative treatment option for HOCM patients with poor medical control.

並列摘要


Hypertrophic obstructive cardiomyopathy (HOCM) might induce left ventricular outflow tract obstruction to get pressure gradient seen in approximately 25% of cases with hypertrophic cardiomyopathy; HCM. Medical therapy was ineffective in about 5% patients. This patient group received septal myectomy operation and had heart failure improvement before 1980 era. Sigwart developed percutaneous transluminal septal myocardial ablation (PTSMA) techniques for symptoms improvement in 1995. By injecting 0.8-1.5ml 99.5% alcohol into the treated vessel to ablate septal myocardium; reduced left ventricular out flow tract pressure. A 50% pressure gradient reduction was the therapeutic goal of this technique. There were 11 consecutive cases received PTSMA between April, 2001 and January, 2008. At our institute, the mean age was 58.7 years old (±10.9). Two cases developed atrioventricle block during this procedure. Mean pressure gradient reduced from 113.3mmHg (±48.2mmHg) to 26.9mmHg (±13.6mmHg) after this procedure (p<0.001). Thickness of septal myocardium decreased from 21.4mm to 18.3mm after treatment (p<0.05). Mean Creatine kinase was 1064.4U/L (±468.4U/L) and Creatine kinase isoenzymes-MB was 162.9U/L (±101.6 U/L) after treatment. Clinical application of PTSMA was over a decade, but it was still controversy on long term result. So far, there were more than 3,000 cases reported in the worldwide. PTSMA was an alternative treatment option for HOCM patients with poor medical control.

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