Tsuchikane E, Nakamura T, Yamazaki K, Kitano K, Izumi M, Otsuji S, Tateyama H, Awata N, Sakurai M, Kobayashi T
First Department of Internal Medicine, Osaka Medical Center for Cancer and Cardiovascular Diseases, Osaka-city, Japan.
Jpn Circ J. 1998 Jul;62(7):537-40. doi: 10.1253/jcj.62.537.
Reduction of septal mass by inducing septal infarction using catheter techniques is a new therapy for hypertrophic obstructive cardiomyopathy (HOCM). We report a case of severe HOCM that was dramatically improved by this non-surgical treatment. A 60-year-old woman with HOCM had suffered dyspnea (NYHA class III) with syncopal attack despite medical treatment. Left heart catheterization showed a resting pressure gradient across the left ventricular outflow tract of 156 mmHg. Two proximal septal branches of the anterior descending coronary artery were catheterized with a balloon catheter by the usual percutaneous coronary angioplasty techniques and were completely blocked by injection of absolute alcohol. The pressure gradient decreased to 26 mmHg after the procedure. Symptoms were markedly improved (NYHA class I) without any medical treatment. The reduced pressure gradient was maintained at the 3-month follow-up catheterization (36 mmHg). Further long-term follow-up is needed, but this treatment would seem to to be a promising technique for reducing pressure gradient in symptomatic patients with HOCM.
通过导管技术诱导间隔梗死以减少间隔质量是肥厚性梗阻性心肌病（HOCM）的一种新疗法。我们报告一例严重HOCM患者经这种非手术治疗后显著改善。一名60岁HOCM女性患者尽管接受了药物治疗仍有呼吸困难（纽约心脏协会III级）并伴有晕厥发作。左心导管检查显示左心室流出道静息压力阶差为156 mmHg。采用常规经皮冠状动脉成形术技术用球囊导管对前降支冠状动脉的两个近端间隔支进行插管，并通过注射无水乙醇将其完全阻塞。术后压力阶差降至26 mmHg。未经任何药物治疗症状即显著改善（纽约心脏协会I级）。在3个月的随访导管检查中压力阶差维持在降低水平（36 mmHg）。尽管还需要进一步长期随访，但这种治疗似乎是降低有症状HOCM患者压力阶差的一种有前景的技术。
