Effectiveness Of Percutaneous Transluminal Septal Myocardial Ablation In Patients With Hypertrophic Obstructive Cardiomyopathy

Background/Objective:Hypertrophic obstructive cardiomyopathy (HOCM), the most common of the genetic cardiovascular diseases, is characterized by asymmetric hypertrophy of the interventricular septum (IVS) with narrowed left ventricular outflow tract. This condition is the most common cause of sudden cardiac death (SCD) in the young, the key to prevention of SCD is early detected and treatmented. The effect of use traditional drugs such as P-blockers, calcium antagonists to treatment the condition is poorly, and some dual-chamber pacemaker therapy is only effective in elderly patients, although surgically relieving the outflow obstruction is the gold standard for the treatment of these patients, it is difficult to be accepted because huge trauma. Percutaneous transluminal septal myocardial (PTSMA) has been gradually carried out in recent years since Sigwart, MD, first reported in1995. This study aimed to investigate the Effectiveness of percutaneous transluminal septal myocardial ablation in patients with hypertrophic obstructive cardiomyopathy. Methods:Between March2013and February2014,15HOCM patients from Department of Cardiology, Second Affiliated Hospital of Zhejiang University School of Medicine were enrolled in the study. PTSMA was performed by all of the patients. Recored the change of LVOTG before and after of PTSMA, and recored the change of IVS, PGmax, PGmean, LVEF,inside diameter of LVOT which detected by Echocardiolgraphy. Cardiac enzyme and complication were tested after PTSMA.Results:The average LVOTGs at rest and after stimulated by Isoproterenol were significantly reduced from (44.6±34.4) mmHg and (121.5±57.5) mmHg respectively before the procedure to (25.6±24.5)mmHg and(63.2±16.7)mmHg respectively after the procedure(P<0.01). Before and3-7days, one month after surgery, the IVS, left ventricular outflow tract diameter, EF did not change significantly (P>0.05) detected by echocardiography. Before the procedure, PGmax was (77.3±58.7) mmHg, after the procedure it was (55.9±21.4) mmHg,one month later it was (56.8±29.9) mmHg (P<0.01). Intraoperative and postoperative seen frequent PVCs, paroxysmal supraventricular tachycardia, once and third degree atrioventricular block and a half junctional escape rhythm, accelerated idioventricular rhythm, some patients required implantation of a temporary pacemaker. Myocardial enzymes were significantly increased after6hours.12hours later, the CK-MB began to decline but Trop-I was increased always. Both of them were significantly declined after3days and tended to be normal.Conclusion:PTSMA technology significantly reduces the resting and excitation LVOTG, PGmax, reactions that the left ventricular outflow tract obstruction were get some relief in HOCM patients, the effectiveness was reliable. However, this technology need for further follow-up to confirm long term efficacy. In addition, how to improve the technology to reducing the incidence of complications is also need to concern.