The Value Of Echocardiography In The Guidance Of Percutaneous Transluminal Septalmyocardial Ablation In Hypertrophic Obstructive Cardiomyopathy

Hypertrophic obstructive cardiomyopathy(HOCM)is chara- cterized by asymmetric hypertrophy of the interventricular septum(IVS),a narrowed left ventricular outflow tract(LVOT)and the subsequent symptoms caused by the obstruction of LVOT.Reducing the left ventricular outflow tract pressure gradient(LVOTG)is the clinical aim for symptomatic patients with HOCM.Some drug-refractory patients may benefit from the implantation of a DDD pacemaker, with a decrease in LVOTG and improvement of symptoms.However, this therapeutic option is not generally recommended.Septal myectomy is an effective method,but has a high perioperation mortality. Percutaneous transluminal septal myocardial ablation (PTSMA) is a promising non-surgical procedure carried out in recent years, with minimal injury,high safety and the same effectiveness as surgical myectomy.Objective Testing the left ventricular outflow tract pressure gradient ( LVOTG ) of hypertrophic obstructive cardiomy- opathy(HOCM) to compare dependablity of the two methods.Simultaneously, appraising the value of echocardiogram in percutaneous transluminal septalmyocardial ablation clinic follow-up of hypertrophic obstructive cardiomyopathy.Method 40 patients with hypertrophic obstructive cardiomyo- pathy during March 1998 to September 2006 in the third clinical hospital of JiLin University who were given anhydrous alcohol septalmyocardial ablation carry out Doppler echocardiography test before operation and cardiac catheterization during operation (the same day with echocardiography), Measuring the left ventricular outflow tract pressure gradient. Measuring the parameter of cardiac diastolic function E/A and LVOTG before the operation and 3 as well as 6 months after the operation. Sorting and analyzing by statistically software.Result The left ventricular outflow tract pressure gradient tested by Doppler echocardiography is 59±26mmHg and it is 70±30mmHg tested by ductus before operation.The LVOTG is 25±12mmHg three months after the operation and 11±9mmHg six months after operation.E/A tested by Doppler echocardiography before the operation is 0.4±0.05. It is 1.0±0.08 three months after theoperation and 1.1±0.07 six months after operation.The NYHA is 3.4±1.2 before the operation.It is 2.6±1.1 three months after the operation and 2.0±0.7 six months after the operation.Conclusion The left ventricular outflow tract pressure gradient that is separatly tested by echocardiography and ductus has better dependablity(coefficient correlation=0.85,P﹥0.05). Com- paring the three phases(before operation, three months after the operation six months after operation), LVOTG reduced continuously and the E/A raised invariably. The two had inverse correlation. LVOTG and NYHA had direct correlation. So echocardiography is a non-destructive and valuable examination in appraising the gradient pressure of hypertrophic obstructive cardiomyopathy before operation and the effect of percutaneous transluminal septalmyo- cardial ablation.