肥厚型梗阻性心肌消融PPT.ppt

LAD S1 After S1 ablation OTW OTW Before ablation PTSMA术注意事项 保持压力泵压力 注射酒精前透视注意球囊位置和充盈情况 酒精慢，0.1~0.3ml/次，每次间隔1min 注意主动脉压力变化，压差下降时应该升高或不变，一旦下降要查找原因 注意心率、节律—AVB? 监测有无交通支开放—最危险 交通支开放病例:44岁，男性 交通支开放病例:44岁，男性 交通支开放病例:44岁，男性 交通支开放病例:44岁，男性 交通支开放病例:44岁，男性 交通支开放病例:44岁，男性 交通支开放病例:44岁，男性 交通支开放病例:44岁，男性 肥厚型梗阻性心肌病的化学消融术Percutaneous Transluminal Septal Myocardial Ablation of HypertrophicObstructive Cardiomyopathy 胡奉环 阜外心血管病医院 冠心病中心 Etiology of Hypertrophic Cardiomyopathy (HCM) Hypertrophic cardiomyopathy (HCM) is inherited as a Mendelian autosomal dominant trait. Estimated prevalence of 0.2% (0.16% in China). It is caused by mutations in 11 genes coding for sarcomeric proteins . Pathophysiology of HCM Ventricular hypertrophy Left Ventricular Outflow （LVOT）Pressure Gradient（PG) Diastolic dysfunction Arrhythmia Myocardial ischemia LVOTPG Left Ventricular Outflow Tract（LVOT） Pressure Gradient (PG) are produced by Apposition with the ventricular septum. Systolic anterior motion (SAM) of the mitral valve. LVOTPG LA AO LV Posterior wall Septum SAM LVOT RV Therapy β-Blockers Verapamil Disopyramide Septal myectomy PTSMA DDD Pacing ICD Primary/secondary prevention of high-risk Sudden Death. Therapy PTSMA：适于瓣下或室中部梗 阻的肥厚型心肌病患者，效果肯定，具有创伤小、花费时间短等特点。但不适于合并瓣膜病和严重肥厚者（30mm） 外科治疗（改良MORROW术）缓解梗阻彻底，适于合并瓣膜病等复杂病例。但创伤大，需体外循环 Percutaneous Transluminal Septal Myocardial Ablation (PTSMA) Sigwart was the first to report a successful nonsurgical myocardial reduction after occlusion of the septal branch using 96% alcohol. PTSMA aims directly to reduce the hypertrophied interventricular septum with associated expansion of the LVOT and reduction of the subaortic gradient. Indications Symptomatic HCM patients with a NYHA class of at least Ⅲ despite of optimal therapy. Patients with substantial side-effects of medication high outflow tract gradients (≥50mmHg at rest or≥100mmHg under stress) can be verified. 术前评估 临床症状：头晕、黑蒙、运动耐量低、心绞痛 Echo MRI CAG 核素心肌显像 Holter 激发试验 ECHO 评估 室壁厚度及部位：基底、中部或心尖 流