Seggewiss H, Faber L, Meyners W, Bogunovic N, Odenthal H J, Gleichmann U
Kardiologische Klinik, Herz- und Diabeteszentrum NRW, Universitätsklinik der Ruhr-Universität Bochum, Bad Oeynhausen, Germany.
Cathet Cardiovasc Diagn. 1998 May;44(1):65-9. doi: 10.1002/(sici)1097-0304(199805)44:1<65::aid-ccd16>3.0.co;2-o.
Percutaneous transluminal coronary angioplasty (PTCA) is an established therapy for coronary artery disease (CAD), whereas percutaneous transluminal septal myocardial ablation (PTSMA) is becoming increasingly significant in the therapy of symptomatic patients with hypertrophic obstructive cardiomyopathy (HOCM). We report the first ever simultaneous treatment, in a 62-yr-old patient, of significant HOCM and a 75% LAD stenosis from which the septal branch to be occluded stemmed. Using a double wire technique, first the septal branch was occluded through a fractional injection of 4 ml absolute alcohol, thus ablating the hypertrophied septal myocardium with reduction of the left ventricular outflow tract (LVOT) gradient at rest from 80 to 9 mmHg. Following this, the LAD stenosis was dilated and stented. Complications, in particular a trifascicular block or ventricular dysrhythmia, did not occur during the hospital stay. To conclude, combined PTSMA and PTCA may be considered as a therapeutic alternative to a combined surgical intervention in individual cases of symptomatic HOCM and CAD, provided that the potential complications are taken into account.
经皮腔内冠状动脉成形术（PTCA）是治疗冠状动脉疾病（CAD）的一种成熟疗法，而经皮腔内室间隔心肌消融术（PTSMA）在有症状的肥厚性梗阻性心肌病（HOCM）患者的治疗中变得越来越重要。我们报告了首例对一名62岁患者同时进行显著HOCM和75%左前降支（LAD）狭窄治疗的案例，要闭塞的间隔支起源于该狭窄处。采用双线技术，首先通过分次注入4毫升无水乙醇闭塞间隔支，从而消融肥厚的室间隔心肌，使静息时左心室流出道（LVOT）压差从80 mmHg降至9 mmHg。在此之后，扩张并置入LAD狭窄处支架。住院期间未发生并发症，尤其是三分支阻滞或室性心律失常。总之，在有症状的HOCM和CAD的个别病例中，若考虑到潜在并发症，联合PTSMA和PTCA可被视为联合手术干预的一种治疗选择。
