Takeda Masafumi, Mori Takao, Ohashi Yoshitaka, Ichikawa Shinobu, Terashima Mitsuyasu, Ejiri Junya, Awano Kojiro
Department of Cardiology, Miki City Hospital, Kasa 58-1, Miki, Hyogo 673-0402.
J Cardiol. 2006 Jun;47(6):313-21.
A 61-year-old man with hypertrophic obstructive cardiomyopathy was treated twice with percutaneous transluminal septal myocardial ablation (PTSMA). The first procedure improved the left ventricular outflow tract pressure gradient (LVOTG) from 148 to 48 mmHg and the New York Heart Association (NYHA) class from III to II in a week. However, the LVOTG increased to 197 mmHg and the NYHA class worsened to III within 3 months. In spite of medical treatment with beta-blocker, syncope attack occurred suddenly. Repeated PTSMA was performed. Just after the second procedure, the LVOTG did not decrease. However, the LVOTG decreased to 81 mmHg and the NYHA class improved to II with 3 months. The different response of pressure gradient in the acute and chronic phase with repeated PTSMA was interesting.
一名61岁的肥厚性梗阻性心肌病男性患者接受了两次经皮腔内室间隔心肌消融术（PTSMA）治疗。首次手术使左心室流出道压力梯度（LVOTG）在一周内从148 mmHg降至48 mmHg，纽约心脏协会（NYHA）心功能分级从III级改善至II级。然而，3个月内LVOTG升至197 mmHg，NYHA心功能分级恶化为III级。尽管使用了β受体阻滞剂进行药物治疗，仍突然发生晕厥发作。于是进行了重复PTSMA。第二次手术后即刻，LVOTG并未下降。然而，3个月时LVOTG降至81 mmHg，NYHA心功能分级改善至II级。重复PTSMA时急性期和慢性期压力梯度的不同反应很有意思。
