Percutaneous Transluminal Septal Alcoholization For The Treatment Of Hypertrophic Obstructive Cardiomyopathy

Objective: To analysis the change and mechanism of the left ventricular outflow tract gradients (LVOTG), arrhythmias and CK-MB enzymatic fraction after percutaneous transluminal septal alcoholization(PTSMA) in the treatment of refractory obstructive hypertrophic cardiomyopathy(HOCM).Methods: 15 patients were referred for PTSMA after Doppler echocardiography. 13 patients( male 7, female 6 )with a mean age of 53. 4卤10. 1 underwent PTSMA; all.in functional class II-III. LVOTG were measured prior to and after the injection of absolute alcohol. After PTSMA, the electrocardiogram were monitored for 72 hours, CK-MB enzymatic fraction once 6-8 hours. Dopple echocardiography were performed after one week.Results: Of 13 patients who concluded alcoholization, complete abolition of the pressure gradient was observed in 3 patients(23. 1%), a basal residual gradient < 30mmHg was observed in 6 patients (46. 2%), 2(15.4%) had an early increase in the LVOTG on predischarge Dopple echocardiography but had a significant acute reduction, a reduction in the LVOTG less than fifty percent of the baseline was observed in 1 (7. 7%). After alcoholization the mean rest LVOTG decrease from 77. 0 38. SmmHg to 21.4 16.3mmHg, p<0. 001. Complete right bundle-branch block (CRBBB) was observed in 46.2% of the patients, 57. 1% of the patients who underwentabsolute alcohol injection in the first septal branch of the anterior descending atery, 33.3% in the second septal branch, the incidence rate of CRBBB is higher in the first septal branch but not significant (P=0. 645). We don't find the relationship between the peak CK-MB enzymatic fraction and the reduction of LVOTG, the amount of alcohol (p>0. 05).Conclusion: PTSMA is effective and safe in the treatment of HOCM, and has been proposed as the most promising alternatives to surgery.