Sigwart U
Department of Invasive Cardiology, Royal Brompton Hospital, London, UK.
Lancet. 1995 Jul 22;346(8969):211-4. doi: 10.1016/s0140-6736(95)91267-3.
Surgery has been the only therapeutic option in patients with hypertrophic obstructive cardiomyopathy who are resistant to drug treatment and sequential pacemaker therapy. I describe a novel catheter-based technique that may replace surgical myocardial reduction in some patients. The technique aims at selective destruction of the hypertrophied part of the left side of the intraventricular septum. If temporary occlusion of the first major septal artery is shown to reduce the intraventricular pressure gradient significantly, absolute alcohol is injected through the inflated balloon catheter to produce a localised infarct. In the first three patients treated with this method, the size of the septal infarct was sufficient to eliminate any subaortic stenosis immediately. Clinical improvement has been maintained up to 12 months. Non-surgical reduction of the septum in hypertrophic obstructive cardiomyopathy warrants further clinical evaluation.
对于药物治疗和序贯起搏器治疗无效的肥厚性梗阻性心肌病患者，手术一直是唯一的治疗选择。我描述了一种新的基于导管的技术，该技术可能会在一些患者中取代外科心肌切除术。该技术旨在选择性破坏室间隔左侧肥厚的部分。如果显示临时阻断第一间隔大动脉可显著降低心室内压力梯度，则通过充盈的球囊导管注入无水酒精以产生局部梗死。在用这种方法治疗的前三位患者中，间隔梗死的大小足以立即消除任何主动脉下狭窄。临床改善一直维持到12个月。肥厚性梗阻性心肌病的非手术性间隔缩小值得进一步的临床评估。
