JV Cardiology, Prague, Czech Republic.
Can J Cardiol. 2024 May;40(5):824-832. doi: 10.1016/j.cjca.2023.09.025. Epub 2023 Sep 27.
In the 30 years since Dr Sigwart's first pioneering procedures, alcohol septal ablation (ASA) has become the standard catheterisation procedure to reduce or eliminate obstruction in the left ventricular outflow tract. This procedure reduces the pressure gradient by 70%-80%, and only 10%-20% of patients have a residual gradient > 30 mm Hg after ASA. The mortality rate of the procedure is < 1%, and ∼ 10% of patients require permanent pacemaker implantation for higher degrees of atrioventricular block. Given the potential risks, ASA should be performed only in centres with extensive experience in the treatment of hypertrophic cardiomyopathy and with comprehensive therapeutic options, including myectomy. In the future, ASA is likely to be increasingly complemented by catheter-based mitral valve repair, which will increase its efficacy.
自 Sigwart 医生首次开展开创性手术以来的 30 年中，酒精室间隔消融术（ASA）已成为减少或消除左心室流出道梗阻的标准导管介入治疗方法。该手术可使压力梯度降低 70%-80%，仅有 10%-20%的患者在接受 ASA 后仍存在>30mmHg 的残余梯度。该手术的死亡率<1%，约 10%的患者因三度房室传导阻滞需要永久性起搏器植入。鉴于潜在风险，ASA 仅应在具有丰富肥厚型心肌病治疗经验且具备全面治疗选择（包括心肌切除术）的中心实施。未来，ASA 可能会越来越多地与基于导管的二尖瓣修复术相结合，从而提高其疗效。
