Durand Eric, Mousseaux Elie, Coste Pierre, Pillière Rémy, Dubourg Olivier, Trinquart Ludovic, Chatellier Gilles, Hagège Albert, Desnos Michel, Lafont Antoine
Service de Cardiologie, AP-HP, Hôpital Européen Georges Pompidou, Université Paris-Descartes, Faculté de Médecine, Unité INSERM U849, Paris, France.
Eur Heart J. 2008 Feb;29(3):348-55. doi: 10.1093/eurheartj/ehm632. Epub 2008 Jan 17.
To evaluate the feasibility and the incidence of complete heart block (CHB) after non-surgical septal myocardial reduction by coil embolization in hypertrophic obstructive cardiomyopathy (HOCM).
Twenty patients with HOCM and drug-refractory symptoms underwent non-surgical myocardial septal reduction by coil embolization with detachable coils. Occlusion of septal perforator branches was successfully performed in all patients. We detected neither ventricular tachycardia nor CHB. One patient presented an interventricular septal defect after the procedure, and died 19 days later. Cardiac magnetic resonance imaging showed, in all patients, an increase in areas of hyperenhancement in the interventricular septum (IVS) compared with baseline. At 6-month follow-up, NYHA functional class and peak oxygen consumption were significantly improved compared with baseline (14.8 +/- 4.5 vs. 18.5 +/- 4.5 mL/kg/min; P = 0.001, respectively). Echocardiography showed a significant reduction of the IVS thickness and left ventricular outflow tract gradient (21 +/- 3 vs. 17 +/- 4 mm, P < 0.0001; 80 +/- 29 to 35 +/- 29 mmHg, P < 0.0001, respectively).
The results of this pilot non-randomized study suggest that non-surgical septal myocardial reduction by coil embolization in HOCM is feasible and does not induce CHB. Larger studies, ideally with a randomized comparison between coil embolization and alcohol septal ablation, are warranted.
评估肥厚性梗阻性心肌病（HOCM）患者经线圈栓塞进行非手术性室间隔心肌减容术后完全性心脏传导阻滞（CHB）的可行性及发生率。
20例有药物难治性症状的HOCM患者接受了使用可脱卸线圈进行的非手术性室间隔心肌减容术，通过线圈栓塞。所有患者均成功实现了间隔穿支的闭塞。我们未检测到室性心动过速或CHB。1例患者术后出现室间隔缺损，并于19天后死亡。心脏磁共振成像显示，与基线相比，所有患者室间隔（IVS）强化区域面积均增加。在6个月随访时，纽约心脏协会（NYHA）心功能分级和峰值耗氧量与基线相比均显著改善（分别为14.8±4.5对18.5±4.5 mL/kg/min；P = 0.001）。超声心动图显示IVS厚度和左心室流出道梯度显著降低（分别为21±3对17±4 mm，P < 0.0001；80±29至35±29 mmHg，P < 0.0001）。
这项初步的非随机研究结果表明，HOCM患者经线圈栓塞进行非手术性室间隔心肌减容术是可行的，且不会诱发CHB。有必要开展更大规模的研究，理想情况下是在线圈栓塞与酒精室间隔消融之间进行随机对照比较。
