Cardiology Division, Department of Medicine, Massachusetts General Hospital and Harvard Medical School, 55 Fruit Street, Boston, MA 02114, USA.
Eur Heart J. 2011 May;32(9):1059-64. doi: 10.1093/eurheartj/ehr013. Epub 2011 Mar 29.
Alcohol septal ablation (ASA) was introduced in 1994 as an alternative to septal myectomy for patients with hypertrophic obstructive cardiomyopathy and symptoms refractory to medical therapy. This procedure alleviates symptoms by producing a targeted, limited infarction of the upper interventricular septum, resulting in an increase in left ventricular outflow tract (LVOT) diameter, a decrease in LVOT gradient, and regression of the component of LV hypertrophy that is due to pressure overload. Clinical success, with improvement in symptoms and reduction in gradient, is achieved in the great majority of patients with either resting or provocable LVOT obstruction. The principal morbidity of the procedure is complete heart block, resulting in some patients in the requirement for a permanent pacemaker. The introduction of myocardial contrast echocardiography as a component of the ASA procedure has contributed to the induction of smaller myocardial infarctions with lower dosages of alcohol and, in turn, fewer complications. Non-randomized comparisons of septal ablation and septal myectomy have shown similar mortality rates and post-procedure New York Heart Association class for the two procedures.
酒精室间隔消融术（ASA）于 1994 年被引入，作为肥厚型梗阻性心肌病患者的一种替代方法，用于治疗对药物治疗有抗药性的患者。该手术通过对室间隔上部进行有针对性的、有限的梗塞来缓解症状，从而导致左心室流出道（LVOT）直径增加、LVOT 梯度降低，以及由于压力超负荷导致的 LV 肥厚成分消退。无论是静息还是可诱发的 LVOT 阻塞，绝大多数患者的临床成功率都很高，症状改善，梯度降低。该手术的主要并发症是完全性心脏阻滞，导致一些患者需要永久性起搏器。心肌对比超声心动图作为 ASA 手术的一部分的引入，有助于用较低剂量的酒精诱导较小的心肌梗塞，从而减少并发症。室间隔消融术和室间隔切除术的非随机比较显示，两种手术的死亡率和术后纽约心脏协会（NYHA）分级相似。
