Brown Morgan L, Schaff Hartzell V
Division of Cardiovascular Surgery, 200 1st St SW, Rochester, MN 55905, USA.
Expert Rev Cardiovasc Ther. 2008 Jun;6(5):715-22. doi: 10.1586/14779072.6.5.715.
While medication is the first line of therapy in obstructive hypertrophic cardiomyopathy, patients who have symptoms refractory to medical treatment or asymptomatic patients with high resting gradients (>or=30 mmHg) may require septal myectomy. Surgical septal myectomy can be performed safely, with excellent survival, relief from symptoms and low morbidity. Alcohol septal ablation is an alternative to surgical treatment, but late outcomes are uncertain. Although both methods of septal reduction relieve left ventricular outflow tract gradients and improve functional status, the need for permanent pacing appears higher with alcohol ablation compared with surgical myectomy. As our understanding of obstructive hypertrophic cardiomyopathy continues to grow, the indications for intervention will evolve. In our practice, septal myectomy remains the gold standard for treatment of obstructive hypertrophic cardiomyopathy.
虽然药物治疗是梗阻性肥厚型心肌病的一线治疗方法，但对药物治疗无效的有症状患者或静息压差较高（≥30 mmHg）的无症状患者可能需要进行室间隔心肌切除术。手术室间隔心肌切除术可安全进行，生存率高，症状缓解且发病率低。酒精室间隔消融术是手术治疗的替代方法，但远期疗效尚不确定。虽然两种室间隔减容方法均可降低左心室流出道压差并改善功能状态，但与手术心肌切除术相比，酒精消融术后永久起搏的需求似乎更高。随着我们对梗阻性肥厚型心肌病的认识不断深入，干预的适应证也将不断演变。在我们的实践中，室间隔心肌切除术仍然是梗阻性肥厚型心肌病治疗的金标准。
