Leal Sílvio, Galeote Guillermo, Jiménez-Valero Santiago, Sánchez-Recalde Angel, Salinas Pablo, Ruiz Alejandro Sáez, Orbe Luís Calvo, Dominguéz Francisco, Moreno Raúl, López-Sendón José Luís
Unidade de Intervenção Cardiovascular, Serviço de Cardiologia, Centro Hospitalar de Lisboa Ocidental, Lisboa, Portugal.
Rev Port Cardiol. 2012 May;31(5):363-71. doi: 10.1016/j.repc.2011.11.006.
Percutaneous septal ablation by alcohol-induced septal branch occlusion was introduced as a new treatment option in symptomatic patients with hypertrophic obstructive cardiomyopathy (HOCM). Our aim was to evaluate procedural and long-term clinical and echocardiographic outcomes in patients with HOCM treated by alcohol septal ablation (ASA) at our center.
This single-center retrospective study included 14 consecutive HOCM patients undergoing percutaneous ASA (66.4 +/- 12.1 years, 71.4% female). At baseline all patients presented persistent symptoms despite optimized medical treatment, left ventricular outflow tract (LVOT) obstruction with a peak gradient > 50 mmHg, systolic anterior motion of the mitral valve, and ventricular septal thickness > or = 15 mm. ASA was considered successful when the LVOT pressure gradient fell to less than 50% of baseline value. All patients had echocardiographic evaluation at baseline, intraprocedure and at follow-up, and a long-term clinical follow-up (25 +/- 38 months) with evaluation of functional class and occurrence of symptoms or cardiovascular events.
Percutaneous ASA achieved a 71.4% acute and 85.7% long-term success rate. Peak LVOT gradient decreased from 104 +/- 40 mmHg at baseline to 58 +/- 30 mmHg intraprocedure (p = 0.03) and 35 +/- 26 mmHg at follow-up (p = 0.001); total gradient decrease was 75 +/- 43 mmHg. Ventricular septal thickness and mitral regurgitation also presented significant decreases during follow-up (from 24 +/- 5 mm to 18 +/- 4 mm, p = 0.02, and from grade 2.4 +/- 0.6 to 1.4 +/- 0.5, p < 0.001, respectively). A tendency for long-term improvement in NYHA functional class (from 2.6 +/- 1.1 to 1.8 +/- 1.4, p = 0.09) was observed. Procedural complications occurred in 6.7% of patients; two deaths and one transient ischemic attack occurred in-hospital, but no long-term clinical events were recorded.
Percutaneous ASA is an effective treatment for symptomatic patients with HOCM, obtaining a marked decrease in LVOT pressure gradient and symptomatic improvement. Despite the occurrence of a significant number of procedural complications, the favorable long-term outcomes underline the potential of ASA as a percutaneous alternative to surgical myectomy.
经酒精诱导的间隔支闭塞进行经皮间隔消融术作为肥厚性梗阻性心肌病（HOCM）有症状患者的一种新治疗选择被引入。我们的目的是评估在我们中心接受酒精间隔消融术（ASA）治疗的HOCM患者的手术过程及长期临床和超声心动图结果。
这项单中心回顾性研究纳入了14例连续接受经皮ASA的HOCM患者（年龄66.4±12.1岁，71.4%为女性）。基线时，所有患者尽管接受了优化的药物治疗仍有持续症状，存在左心室流出道（LVOT）梗阻，峰值压差>50 mmHg，二尖瓣收缩期前向运动，室间隔厚度≥15 mm。当LVOT压力梯度降至基线值的50%以下时，ASA被认为成功。所有患者在基线、术中及随访时均进行了超声心动图评估，并进行了长期临床随访（25±38个月），评估功能分级以及症状或心血管事件的发生情况。
经皮ASA的急性成功率为71.4%，长期成功率为85.7%。LVOT峰值压差从基线时的104±40 mmHg降至术中的58±30 mmHg（p = 0.03），随访时降至35±26 mmHg（p = 0.001）；总压差降低了75±43 mmHg。随访期间室间隔厚度和二尖瓣反流也显著降低（分别从24±5 mm降至18±4 mm，p = 0.02；从2.4±0.6级降至1.4±0.5级，p < 0.001）。观察到纽约心脏协会（NYHA）功能分级有长期改善的趋势（从2.6±1.1降至1.8±1.4，p = 0.09）。6.7%的患者发生了手术并发症；住院期间发生了2例死亡和1例短暂性脑缺血发作，但未记录到长期临床事件。
经皮ASA是治疗有症状HOCM患者的有效方法，可使LVOT压力梯度显著降低，症状改善。尽管发生了大量手术并发症，但良好的长期结果突显了ASA作为手术心肌切除术的经皮替代方法的潜力。
