To Analyze The Efficacy And Safety Of Different Doses Of Alcohol In Chemical Ablation Of Hypertrophic Obstructive Cardiomyopathy

Objective:To observe and analyze the efficacy and safety of different doses of alcohol in chemical ablation of hypertrophic obstructive cardiomyopathy.Bcakground:Hypertrophic cardiomyopathy is a kind of hereditary cardiomyopathy,which is divided into obstructive cardiomyopathy and non-obstructive cardiomyopathy.At present,the main treatment methods for hypertrophic obstructive cardiomyopathy patients with poor drug treatment effect include: myocardial resection and percutaneous transluminal septal myocardial ablation(PTSMA),implantation of permanent pacemakers,etc.PTSMA has been widely used in clinical practice due to its small trauma and its curative effect is equivalent to that of isolated myocardial resection in external departments.However,there is no clear result on the effect and safety of the dosage of alcohol used in patients with hypertrophic obstructive cardiomyopathy.Methord:A total of 251 patients with hypertrophic obstructive cardiomyopathy who underwent percutaneous transluminal septal myocardial ablation from January 1999 to January 2015 in the heart center of Liaoning provincial people's Hospital were collected.According to the dose of alcohol,it was divided into low dose group(? 1.5ml),medium dose group(? 3.0 ml)and high dose group(> 3.0 ml).The difference of left ventricular outflow-tract gradients,ventricular septal thickness,NYHA cardiac function grade and the incidence of complications after chemical ablation between different groups were analyzed and compared.Results:The low dose group,middle dose group and high dose group accounted for35.9 %,51.4 % and 12.7 % of the study respectively.There was no statistical difference in clinical baseline between the three groups(p > 0.05).Compared with low-dose group and medium-dose group,the high-dose group had worse NYHA grade,CCS grade and EF value,but the difference was not statistically significant(p > 0.05).With the increase dosage of alcohol,the percentage of LVOTG decrease increases with statistical difference(p < 0.05).From the point of view of intraoperative complications,the high-dose group has higher intraoperative complications,the low-dose group has lower intraoperative complications,and the middle-dose group is between the two groups with statistical difference(p < 0.05).Compared with the high-dose group,the low-dose group had a higher incidence of PTSMA after operation(p < 0.05),and the high-dose group had a higher incidence of permanent pacemaker implantation(p < 0.05).There was no significant difference between low-dose group and middle-dose group in PTSMA and permanent pacemaker implantation again(p >0.05).The IVS and LVOTG of the three groups at discharge,6 months after discharge and 12 months after discharge showed a downward trend and had statistical significance(p < 0.05).NYHA heart function grade 3 / 4 showed a decreasing trend in the three groups at 6 months and 12 months compared with the preoperative level,with statistical difference(p < 0.05).Conclusions:The increase of dosage of alcohol can improve the postoperative curative effect,but it also increases the postoperative complications,while ensuring the PTSMA effect,reducing alcohol dosage as much as possible to reduce the postoperative complications.Low dosage of alcohol(< 1.5 ml)can also achieve satisfactory postoperative results and reduce complications.From the experience of our single center,alcohol dosage ? 3 ml is reasonable for most patients.