| BackgroundsHypertrophic obstructive Cardiomyopathy (HOCM) is a relatively common disease with diverse genetics, morphology, function and clinical manifestations, and characteristic of asymmetric septal hypertrophy, dynamic left ventricular outflow tract obstruction. Patients with HOCM commonly exhibit dyspnea, chest pain, palpitation, syncope, sudden cardiac death(SCD),etc, and has an estimated annual mortality of 1.7%-4%.HOCM is a genetic disease with an autosomal dominant mode of inheritance, and has genetic heterogeneousness. Diagnosis of HOCM mainly relay on ultrasound cardiography. Conventional negative inotropic substances such as β -blockers, verapamil, propiram can reduce LVOT obstruction, relief symptoms, and may use anti-arrhythmic drugs to prevent SCD. Even if many patients take maxium dosage medicine ,but still have symptoms. It has report that cibenzoline (class I a antiarrhythmic drugs)can reduce LVOT obstruction, but the effect and side-effect need advance observation. If other methods have no effect, surgery to remove a part of obstructive septal Cardiomyopathy, and may obtain good symptoms and hemodynamic results without impairing LV function.But surgery need exreacorporeal circulation, open the chest ,and have a relatively higher morbility. Furthermore,it isstill unclear that whether it is benefit to prognosis or not,recently is not inclined to surgical myectomy.AV sequential pacing of DDD may reduce LVOT obstruction and improve symptoms through altering cardiomyopathy exciting mode,optimizing artrial contracting time,and is considered a promising alternative therapeutic method,but it still remains advance observation wether DDD pacig can improve symptoms,reduce LVOT obstruction,enhance LV diastolic function, long-term prognosis and prolong life in patients with HOCM.Study suggest that the good acute effect of DDD pacing own to placebo effect. So far,it is no conclusion wether mitral valve replacement has certain therapeutic effect or not.In 1995,Sigwart published the first report on definitive alcohol-induced septal reduction in 3-severely symptomatic patients,and showed promising results concerning symptom and LVOT gradient reduction.Our department performed PTSMA relatively early,but the acute effect and security of PTSMA for HOCM are seldom evaluated at home.So study on PTSMA is essential indeed, in order to make a objective evaluation on PTSMA for HOCM.PurposesPatients with symptomatic HOCM were performed PTSMA,and applied to Doppler echocardiography to monitor some parameters of pre-and post-PTSMA,in order to evaluate the acute effect and security of PTSMA for HOCM.Objects and methodsEight patients with severe HOCM were treated with PTSMA.NYHA function class was 1.88±0.64,monitored the patients with doppler echocardiography in pre-and post-intervention.The first or second septal artery supplying the hypertrophic area was injected 1.5 to 5ml of absolute ethanol.Blood pressure,electrocardiogram and serial left and right heart catherization were observed during ablation and several days after intervention.Resultsl.LVOT Obstruction:LVOTG at rest was reduced from 41.58 ± 13.37mmHg to24.05 ± 12.98mmHg(p<0.05)after PTSMA.6 patients had the obstruction-associated phenomena of SAM before intervention,and SAM of 2 patients disappeared after intervention.2.Systolic and Diastolic LV Function and LV HypertrophyrBefore and after PTSMA,LV end-diastolic diameter,LV ejection fraction,fractional shortening, septal thickness, LV post-wall thickness and left arteial diameter of the patients with HOCM,had no statistical significance.3.Cardiac Enzyme Changes:The creatine kinase(CK)began to raise after 2 to 7h,was 434.63 ±251.01u/L(39~ 770) with an MB fraction of 57.38 ± 43.06u/L(ll-151),and CK peak was 1133.25±200.56u/L(880- 1493) after 4-24h,with an MB fraction of 126.38 ±66.02u/L(50-252). Cardiac troponinI (CTnI) began to raise after 2-4h,was 60.65 ± 86.11ng/mL(0.30-254.3),and peak was 204.36±95.88ng/mL(92.5-358.3). Cardiac enzyme changes were related to... |
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