Tekieli Łukasz, Pieniazek Piotr, Podolec Piotr, Tomkiewicz-Pajak Lidia, Płazak Wojciech, Musiałek Piotr, Leśniak-Sobelga Agata, Przewłocki Tadeusz, Biernacka Barbara, Zmudka Krzysztof, Tracz Wiesława
Klinika Chorób Serca i Naczyń, Krakowski Szpital Specjalistyczny im. Jana Pawła II, Uniwersytet Jagielloński, Collegium Medicum, Kraków.
Przegl Lek. 2006;63(8):628-32.
Percutaneous transluminal septal myocardial ablation (PTSMA) is becoming an alternative to surgical myectomy in the treatment of severe, drug refractory, hypertrophic obstructive cardiomyopathy (HOCM). The aim of our study was to analyze early results, complications and long-term follow-up in patients after PTSMA.
Out of eighteen patients [11 M] initially accepted for PTSMA, the procedure was performed in 12 patients [6 M] age from 22 to 70 y. All the patients underwent clinical evaluation, echocardiography and cardiopulmonary exercise testing (CPX) before the procedure, and after a median of 38 months of observation. In echo-cardiography left ventricle outflow tract gradient (LVOTG) and intraventricular septum diastolic diameter were assessed. The following parameters of CPX were analyzed: exercise duration, anaerobic threshold, peak oxygen consumption, peak exercise heart rate and carbon dioxide ventilating equivalent.
The procedure was successful in 11 patient. There were 2 acute complications: 3rd degree AV block requiring peacemaker implantation and LVOTG increase with SAM exacerbation requiring urgent cardiosurgical intervention. During long-term follow-up 1 cerebral stroke and 1 death occurred. PTSMA resulted in significant reduction of left ventricle outflow tract gradient (89 +/- 44 vs. 17 +/- 17 mmHg) and intraventricular septum diastolic diameter (24 +/- 4 vs 18 +/- 5 mm) (p < or = 0.01 for both). We also observed improvement of CPX parameters: exercise duration (487 +/- 268 vs. 730 +/- 292 sec), anaerobic threshold (34.3 +/- 8.9 vs. 53.2 +/- 13.4% VO2max predicted), peak oxygen consumption (18.5 +/- 6 vs. 26.8 +/- 10.1 ml/kg/min), peak exercise heart rate (70.3 +/- 8.3 vs. 83.6 +/- 11.7%) and carbon dioxide ventilating equivalent (31 +/- 6.1 vs. 28 +/- 4.8); (p < or = 0.01 for all).
PTSMA is an effective method of treatment in patients with severe, drug refractory HOCM. PTSMA is safe and is associated with a low percentage of severe complications.
经皮腔内室间隔心肌消融术（PTSMA）正成为治疗严重、药物难治性肥厚性梗阻性心肌病（HOCM）的外科心肌切除术的替代方法。我们研究的目的是分析PTSMA术后患者的早期结果、并发症及长期随访情况。
在最初接受PTSMA的18例患者[11例男性]中，12例患者[6例男性]，年龄22至70岁，接受了该手术。所有患者在手术前以及中位观察38个月后均接受了临床评估、超声心动图检查和心肺运动试验（CPX）。在超声心动图检查中，评估左心室流出道梯度（LVOTG）和室间隔舒张期直径。分析CPX的以下参数：运动持续时间、无氧阈值、峰值耗氧量、运动峰值心率和二氧化碳通气当量。
11例患者手术成功。有2例急性并发症：1例三度房室传导阻滞需要植入起搏器，1例LVOTG增加伴SAM加重需要紧急心脏外科干预。在长期随访中，发生1例脑卒中和1例死亡。PTSMA导致左心室流出道梯度显著降低（89±44 vs. 17±17 mmHg）和室间隔舒张期直径显著降低（24±4 vs 18±5 mm）（两者p≤0.01）。我们还观察到CPX参数有所改善：运动持续时间（487±268 vs. 730±292秒）、无氧阈值（34.3±8.9 vs. 53.2±13.4%预测VO2max）、峰值耗氧量（18.5±6 vs. 26.8±10.1 ml/kg/min）、运动峰值心率（70.3±8.3 vs. 83.6±11.7%）和二氧化碳通气当量（31±6.1 vs. 28±4.8）；（所有p≤0.01）。
PTSMA是治疗严重、药物难治性HOCM患者的有效方法。PTSMA安全，严重并发症发生率低。
