肥厚型梗阻性心肌病化学消融术
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PTSMA aims directly to reduce the hypertrophied interventricular septum with associated expansion of the LVOT and reduction of the subaortic gradient.
Haines DE ,et al J Cardiovasc Electrophysiol. 1994 Jan;5(1):41-9.
Percutaneous Transluminal Septal Myocardial Ablation (PTSMA)
In1994, Sigwart was the first to report a successful nonsurgical myocardial reduction after occlusion of the septal branch using 96% alcohol.---Non-surgical myocardial reduction for hypertrophic obstructive cardiomyopathy------ SAS
概述—病因：不明
遗传性因素： 是主要病因，大约50%～55%的 肥厚型心肌病患者有家族史，属于常染色体 显性遗传病，肥厚型心肌病的遗传学说已被 公认
钙调节紊乱
诊断
症状与体征 心电图特征 超声心动图特征：非对称性室间隔增厚>12mm，室间隔/左
室后壁>1.3；室间隔厚度≥18mm并有二尖瓣收缩期前移， 可区分梗阻性与非梗阻性 左心室造影：左心室流出道压力差及左室形态特征可以确 立诊断 核磁共振（MRI)：室壁增厚和流出道狭窄
LVOTPG
源自文库RV
Septum
LV
AO
LVOT
SAM
Posterior wall
LA
SAM Sign
LVOTPG
How to reduce the hypertrophy?
Septal myectomy PTSMA
HCOM治疗
药物 外科切除 经皮室间隔化学消融术（PTSMA) 双强起搏器
病理特点：左心室血液充盈受阻，舒张期顺应性下 降
分型：梗阻型和非梗阻型两型 人群发病率0.02%-0.2%
概述
病死率1.4%（儿童可高至6%)，其中猝死0.7%， 心衰0.5%，中风0.2%
Koga等报道日本的肥厚型心肌病患者预后， 5年随访的年病死率为 2.3%～2.9%，其中心尖 肥厚型心肌病病死率仅为0.3%，约1/10的患者 逐渐发生左心室扩张和心力衰竭，最后类似 扩张型心肌病被称为扩张期肥厚型 心肌病
Sigwart U.Lancet. 1995;346:211e4
Alcohol Septal Ablation (SAS)
Myocardial contrast echocardiography: a reproducible technique of myocardial opacification for identifying regional perfusion deficits
肥厚型梗阻性心肌病化学消融术 —基础与临床
Percutaneous Transluminal Septal Myocardial Ablation of Hypertrophic Obstructive Cardiomyopathy
概述
肥厚型心肌病(hypertrophic cardiomyopathy，HCM) 是一种以心肌进行性肥厚、心室腔进行性缩小为特 征
Obstructive Mechanism
Left ventricular outflow tract obstruction is present at rest in approximately 25% of HCM patients
In addition, 50% of patients without obstruction at rest can generate significant intraventricular gradients with exercise
Obstructive Mechanism
Mechanical impedance at the subaortic level Owing to mitral valve systolic anterior motion
(SAM) and mid-systolic contact with ventricular septum Mitral regurgitation due to incomplete leaflet coaptation
Targeting percutaneous transluminal septal
ablation for HOCM by intraprocedural ECHO
monitoring.
Tei Cet al. Circulation.1983 Mar;67(3):585-93. Faber L,et al. J Am Soc Echocardiogr.2000 Dec;13(12):1074-9.
Alcohol Septal Ablation (SAS)
理论基础
Intracoronary ethanol ablation in swine: characterization of myocardial injury in target and remote vascular beds
Conclusion: Intracoronary ethanol ablation Lesions are generally produced within the distribution of the targeted coronary bed, but are also frequently associated with reflux to a second vascular distribution.
Haines DE ,et al J Cardiovasc Electrophysiol. 1994 Jan;5(1):41-9.
Percutaneous Transluminal Septal Myocardial Ablation (PTSMA)
In1994, Sigwart was the first to report a successful nonsurgical myocardial reduction after occlusion of the septal branch using 96% alcohol.---Non-surgical myocardial reduction for hypertrophic obstructive cardiomyopathy------ SAS
概述—病因：不明
遗传性因素： 是主要病因，大约50%～55%的 肥厚型心肌病患者有家族史，属于常染色体 显性遗传病，肥厚型心肌病的遗传学说已被 公认
钙调节紊乱
诊断
症状与体征 心电图特征 超声心动图特征：非对称性室间隔增厚>12mm，室间隔/左
室后壁>1.3；室间隔厚度≥18mm并有二尖瓣收缩期前移， 可区分梗阻性与非梗阻性 左心室造影：左心室流出道压力差及左室形态特征可以确 立诊断 核磁共振（MRI)：室壁增厚和流出道狭窄
LVOTPG
源自文库RV
Septum
LV
AO
LVOT
SAM
Posterior wall
LA
SAM Sign
LVOTPG
How to reduce the hypertrophy?
Septal myectomy PTSMA
HCOM治疗
药物 外科切除 经皮室间隔化学消融术（PTSMA) 双强起搏器
病理特点：左心室血液充盈受阻，舒张期顺应性下 降
分型：梗阻型和非梗阻型两型 人群发病率0.02%-0.2%
概述
病死率1.4%（儿童可高至6%)，其中猝死0.7%， 心衰0.5%，中风0.2%
Koga等报道日本的肥厚型心肌病患者预后， 5年随访的年病死率为 2.3%～2.9%，其中心尖 肥厚型心肌病病死率仅为0.3%，约1/10的患者 逐渐发生左心室扩张和心力衰竭，最后类似 扩张型心肌病被称为扩张期肥厚型 心肌病
Sigwart U.Lancet. 1995;346:211e4
Alcohol Septal Ablation (SAS)
Myocardial contrast echocardiography: a reproducible technique of myocardial opacification for identifying regional perfusion deficits
肥厚型梗阻性心肌病化学消融术 —基础与临床
Percutaneous Transluminal Septal Myocardial Ablation of Hypertrophic Obstructive Cardiomyopathy
概述
肥厚型心肌病(hypertrophic cardiomyopathy，HCM) 是一种以心肌进行性肥厚、心室腔进行性缩小为特 征
Obstructive Mechanism
Left ventricular outflow tract obstruction is present at rest in approximately 25% of HCM patients
In addition, 50% of patients without obstruction at rest can generate significant intraventricular gradients with exercise
Obstructive Mechanism
Mechanical impedance at the subaortic level Owing to mitral valve systolic anterior motion
(SAM) and mid-systolic contact with ventricular septum Mitral regurgitation due to incomplete leaflet coaptation
Targeting percutaneous transluminal septal
ablation for HOCM by intraprocedural ECHO
monitoring.
Tei Cet al. Circulation.1983 Mar;67(3):585-93. Faber L,et al. J Am Soc Echocardiogr.2000 Dec;13(12):1074-9.
Alcohol Septal Ablation (SAS)
理论基础
Intracoronary ethanol ablation in swine: characterization of myocardial injury in target and remote vascular beds
Conclusion: Intracoronary ethanol ablation Lesions are generally produced within the distribution of the targeted coronary bed, but are also frequently associated with reflux to a second vascular distribution.