Nonsurgical septal reduction for hypertrophic obstructive cardiomyopathy - Outcome in the first series of patients
Nonsurgical septal reduction for hypertrophic obstructive cardiomyopathy - Outcome in the first series of patients
复制标题
DOI：
10.1161/01.cir.95.8.2075
复制
发表时间：
1997-04-15
期刊：
影响因子：
37.8
通讯作者：
Sigwart, U
中科院分区：
文献类型：
--
作者：
Knight, C;Kurbaan, AS;Sigwart, U
背景：一些肥厚型梗阻性心肌病患者可能通过减少左室流出道梗阻程度而获得症状缓解。方法和结果18例患者采用选择性冠状动脉内注射酒精诱导局限性室间隔梗塞。患者在手术前、术后第一天和术后3个月的中位时间进行了左室大小的超声心动图测量和左室流出道压差的多普勒超声心动图评估。此外，患者在非手术前和非手术后3个月进行了运动试验和症状评估。术后左室流出道梗阻显著减少(术前67 mm Hg[95%CI，48~57 mm Hg]；术后25 mm Hg[95%CI，16~34 mm Hg]；P=.0006)，并持续3个月随访(22 mm Hg[95%CI，12~32 mm Hg]；P=.001)。这与症状的显著改善有关。运动能力有轻微但不显著的增加(n=10；术前418秒[95%CI，273至563秒]；术后452秒[95%CI，283至621秒])。非手术间隔缩小对左心室内径无明显影响。结论非手术间隔缩小可明显减轻肥厚型梗阻性心肌病患者左室流出道梗阻，改善部分患者的症状。在选定的患者中，这项技术可能会提供一种替代肌瘤切除术的方法。
Background Some patients with hypertrophic obstructive cardiomyopathy may gain symptomatic relief from a reduction in the extent of obstruction to left ventricular outflow. We present the outcome of the first series of patients treated with an alternative method of gradient reduction using catheter techniques.Methods and Results Eighteen patients were treated with selective intracoronary alcohol injection to induce localized septal infarction. Patients underwent echocardiographic measurement of left ventricular dimensions and Doppler echocardiographic evaluation of left ventricular outflow tract gradients before the procedure, on the first postoperative day, and at a median follow-up of 3 months after the procedure. In addition, patients underwent exercise testing and symptom evaluation before and 3 months after nonsurgical septal reduction. There was a significant reduction in left ventricular outflow tract obstruction after the procedure (preprocedure, 67 mmHg [95% CI, 48 to 57 mm Hg]; postprocedure, 25 mm Hg [95% CI, 16 to 34 mmHg]; P=.0006), which persisted at 3-month follow-up (22 mm Hg [95% CI, 12 to 32 mm Hg]; P=.001). This was associated with a significant improvement in symptoms. There was a small but not significant increase in exercise capacity (n=10; preprocedure, 418 seconds [95% CI, 273 to 563 seconds]; postprocedure, 452 seconds [95% CI, 283 to 621 seconds). Left ventricular dimensions were not significantly altered by nonsurgical septal reduction.Conclusions Nonsurgical septal reduction significantly reduces left ventricular outflow tract obstruction and improves symptoms in some patients with hypertrophic obstructive cardiomyopathy. The technique may provide an alternative to myomectomy in selected patients.