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Surgical outcomes and strategy of hypertrophic obstructive cardiomyopathy

Journal of Zhejiang University-Science B(Biomedicine & Biotechnology) 2006年第2期7卷 148-153页

作者：朱亚彬 RAJAN S. KURIAN V.M. 刘志勇 Department of Thoracic and Cardiovascular Surgery Affiliated Su Bei Hospital Yangzhou University Yangzhou 225001 China Department of Thoracic and Cardiovascular Surgery Madras Medical Mission Moggapair East Chennai 600037 India Department of Thoracic and Cardiovascular Surgery Affiliated Zhong Da Hospital Southeast University Nanjing 210009 China

Objective： To evaluate the surgical clinical results of hypertrophic obstructive cardiomyopathy. Methods： We retrospectively collected data on 24 patients who underwent surgical management in the past ten years in two hospitals in China and Madras Medical Mission in India. Myomectomy was carried out on all patients. Among them 3 patients underwent mitral valve replacement; 2 patients underwent mitral valve repair （anterior mitral leaflet plication）; 2 patients underwent aortic valve replacement; 1 patient underwent aortic valve repair; 2 patients underwent aortic root replacement; 1 patient underwent Bentall＇s procedure and 1 patient underwent coronary artery bypass grafting because of a breached muscle bridge, Results： One patient died of post-operative heart failure. The mean follow-up time was 4.3 years, There was significant improvement in the symptomatic status. Sixteen patients were asymptomatic with good effort tolerance and only four patients had New York heart association （NYHA） Classes Ⅰ-Ⅱ due to associated valvular lesions, Conclusion： Our experience proved that symptomatic hypertrophic obstructive cardiomyopathy or non-symptomatic hypertrophic obstructive cardiomyopathy with combined heart disease is indication for surgery as surgical intervention could get better clinical results in this kind of patients compared with other non-surgical method because it beneficially reduces the systolic anterior motion （SAM） of the mitral valve leaflet, which could not be avoided by other non-surgical treatment.

关键词： hypertrophic obstructive cardiomyopathy Systolic anterior motion Myomectomy

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Left ventricular endocardial pacing predicts the reduction of left ventricular outflow tract pressure gradient immediately after percutaneous transseptal myocardial ablation in patients with hypertrophic obstructive cardiomyopathy refractory to medicatio

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Chinese Medical Journal 2007年第7期120卷 562-568页

作者： CHEN Shao-liang DAI Zhen-lin LI Zhan-quan HU Zuo-ying YE Fei ZHANG Jun-jie ZHANG Fen-fu LUO Jun ZHU Zhong-sheng LIN Song WU Cheng-quan TIAN Nai-liang Department of Cardiology Nanjing First Hospital of Nanjing Medical University Nanjing 210006 China Department of Cardiology People＇s Hospital of Liaoning Province Shenyang 110016 China

Background hypertrophic obstructive cardiomyopathy （HOCM） carries an increased risk for sudden cardiac death. No data regarding the percutaneous transseptal myocardial ablation （PTSMA） and epicardial left ventricular pacing （LVP） were reported. Methods Seven patients with recurrent symptoms and increased resting left ventricular outflow tract pressure gradient （LVOTG） after PTSMA and another 14 patients with HOCM without history of PTSMA were studied. Both resting and dobutamine stress echocardiography, PTSMA and LVP were routinely performed. Results In patients without previous PTSMA procedure, mild reduction of resting LVOTG was detected at 5 minutes after left ventricular pacing, and this reduction became significant at 10 minutes. All patients were divided into successful and unsuccessful groups according to their response to LVP. In contrary to patients in unsuccessful group, resting and R-S2 stimuli-induced LVOTG during PTSMA procedure were decreased dramatically （（9±5） mmHg vs （58±12） mmHg, （12±2） mmHg vs （113±27） mmHg, P〈0.001）. Analysis of Logistic regression demonstrated that only LVOTG level dudng left ventdcular pacing was an independent factor predicting the reduction of LVOTG immediately after PTSMA （odds ratio （OR）, 0.59; 95% CI 2.67 to 5.82; P=0.0002）. Conclusion Left ventricular endocardial temporary pacing plays a critical role in predicting acute effect on the reduction of LVOTG immediately after PTSMA procedure.

关键词： hypertrophic obstructive cardiomyopathy left ventricular outflow tract pressure gradient left ventricular endocardial pacing percutaneous transseptal myocardial ablation

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Midterm outcomes of percutaneous transluminal septal myocardial ablation in patients with hypertrophic obstructive cardiomyopathy refractory to medication

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Chinese Medical Journal 2006年第13期119卷 1121-1124页

作者： CHEN Shao-liang YE Fei XU Zu-ling LIN Song DUAN Bao-xiang DAI Zhen-ling SHAN Shou-jie ZHANG Jun-jie Cardiological Division Nanjing First Hospital of Nanjing MedicalUniversity Nanjing 210006 China Nanjing Heart Centre Nanjing 210006 China

hypertrophic obstructive cardiomyopathy （HOCM） is a genetic disorder characterized by severe asymmetric hypertrophy of the interventricular septum （IVS） in the absence of any other systemic or cardiac diseases. The predominant abnormal haemodynamics are caused by increased left ventricular outflow tract pressure gradient （LVOTG） and abnormal systolic anterior motion of mitral valve.

关键词： hypertrophic obstructive cardiomyopathy percutaneous transluminal septal myocardial ablation left ventricular outflow tract pressure gradient

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Cardiac electromechanical mapping in analyzing the mechanism of left ventricular remodeling immediately after percutaneous transluminal septal ablation in patients with hypertrophic obstructive cardiomyopathy

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Chinese Medical Journal 2005年第21期118卷 1779-1785页

作者： CHEN Shao-liang HUANG Jun YE Fei SHAN Shou-jie ZHANG Jun-jie DUAN Bao-xiang CHEN Yun-dai Cardiological Division Nanjing First Hospital of Nanjing Medical University Nanjing 210006 China Cardiological Division Jiangsu Provincial People＇ s HospitalNanjing 210029 China Cardiological Division Anzhen Hospital of Capital Medical University Beijing 100029 China

Background Effect of percutaneous transluminal septal ablation （PTSA） with ethanol injection on electromechanical remodeling of left ventricule still remains unknown. This study was conducted to assess the potential significance of cardiac electromechanical mapping （CEMM） in analyzing the left ventricular remodeling before and immediately after percutaneous transseptal myocardial ablation （PTSMA） in patients with hypertrophic obstructive cardiomyopathy （HOCM）.Methods Eight patients with drug-refractory HOCM and 6 patients with hypertrophic cardiopathy （HM） without increased left ventricular outtract gradien （LVOTG） were enrolled into the present study. CEMM was undergone in patients with HOCM before and immediately after PTSA procedure, and in patients with *** PTSA was successful in all patients with HOCM, LVOTG significantly decreased from （62.87±21.16） mmHg to （ 12. 73± 3.05 ） mmHg immediately after ablation procedure. Value of UVP in septal-base segment in HM group was higher than that in HOCM group [ （22.79 ± 2. 34） mV vs （ 18.54 ± 1.76） mV ]. In patients with HOCM, lateral-middle and -base segments had lowest value of UVP [ （ 15.93±1.11 ） mV and （15.83 ±1.07）mV] before PTSA. Value of UVP at posterior-middle segment decreased from （23.58 ±2. 21 ） mV pre-PTSA to （18.89 ±1.91 ）mV post-procedure, PTSA led to significant increase of UVP at lateral-middle segment. Septal region in patients with HM and septal-middle, septal-base, posterior-base segments in HOCM had lower value of local linear shortening （LLS） among all patients in both HOCM and HM groups. PTSA resulted in significant reduction of LLS in anterior region and at septal-apex segment. Anterior-base and septal- middle segments in patients with HM had lowest value of local active time （ LAT）, and significantly differentiated from that in patients with HOCM [ （ -8.57 ±0. 68）ms vs （ - 18.61 ± 1.02）ms, （ -6. 75 ±0. 37）ms vs （ - 21.90 ± 0. 96）ms, respectively ]. LAT at septal-middle and -base segments in

关键词： hypertrophic obstructive cardiomyopathy percutoneous transluminal septal ablation cardiac electromechanical mapping remodeling

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Successful treatment with biventricular pacing in a patient with hypertrophic obstructive cardiomyopathy

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Chinese Medical Journal 2011年第7期124卷 1105-1108页

作者： HE Ji-qiang JIANG Teng-yong WANG Yun-long WANG Yan LU Shu-zheng Department of Cardiology Beijing Anzhen Hospital Capital Medical University & Institute of Beijing Heart Lung and Vascular Disease Beijing 100029 China

We report the effects of biventricular pacing in a patient with hypertrophic obstructive cardiomyopathy （HOCM） refractory to medical therapy. A 58-year-old man with HOCM had suffered from dyspnea, chest pain and palpitation for 5 years. Cardiac catheterization showed a left ventricular outflow tract （LVOT） gradient of 80 mmHg. He refused septal myomectomy and the septal ablation was not available. Based on intraoperative pressure measurements, he was implanted with biventricular pacing and LVOT gradient decreased to 10 mmHg. During the follow-up period of 6 months, the patient＇s symptoms were markedly improved. Biventricular pacing may be an alternative therapy for patients with HOCM.

关键词： hypertrophic obstructive cardiomyopathy biventricular pacing

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Myocardial condition after transcoronary ablation predicts the curative effect in patients with hypertrophic obstructive cardiomyopathy

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Chinese Medical Journal 2006年第3期119卷 246-249页

作者： JIANG Teng-yong WU Xue-si HAN Zhi-hong JIA Chang-qi MI Hong-zhi GAO Yue-chun ZHANG Xiao-ling Department of Cardiology Beijing Anzhen Hospital Affiliated to the Capital University ofMedical Sciences Beijing 100029 China Department of Nuclear Medicine Beijing Anzhen Hospital Affiliated to the Capital University ofMedical Sciences Beijing 100029 China

Transcoronary ablation of septal hypertrophy （TASH） has been recommended as an option forpatients with drug-refractory hypertrophic obstructive cardiomyopathy （HOCM）. However, its outcome is varied, and some factors are attributed to the diversity results.1 Up to now, there is no study on the influence of the ablated myocardium＇s condition on the outcome. We retrospectively analyzed the myocardial perfusion imaging （MPI） obtained before and early after TASH in our patients to explore the relationship between the ablated myocardium＇s condition and the clinical outcome.

关键词： hypertrophic obstructive cardiomyopathy transcoronary ablation of septal hypertrophy myocardialperfusion imaging pressure gradient of left ventricular outflow tract outcome assessment

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Electrical storm after percuteneous transluminal septal myocardial ablation on hypertrophic obstructive cardiomyopathy : a case report

Electrical storm after percuteneous transluminal septal myoc...

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2012年浙江省心电生理与起搏学术年会

作者： Yi-ping He Hangyuan Guo Yu-fang Qiu Fang Peng Yangbo Xing Department of Cardiology Shaoxing People’s Hospital

We describe a 62-year-old male patient. He had been diagnosed with hypertrophic obstructive cardiomypathy and were refractory to medical treatments. He was admimitted to our hospital for percutaneous transluminal septal myocardial ablation (PTSMA). Temporary cardiac pacemaker was inserted before the injection of ethanol. Completely atrial ventricular block happened soon after PTSMA. One hour after PTSMA, Ventricular arrhythmia storms occurred. They were refractory to lidocaine, amiodarone and magenesium sulfate injection,six times of electrical conversions and defibrillations were performed. The ventricular fibrillations did not stopped until the injection of esmolol hydrochloride. Completely atrial-ventricular block disappered 36 hours after PTSMA. Transthocic echocardiography (TTE) was performed before and 1-week after PTSMA. The left ventricular outflow-tract pressure gradient (LVOTG) was much lower than that of Pre-PTSMA, with 25mmHg vs 53 mmHg. TTE was peformed 3 months after PTSMA, it showed sustained improved in LVOTG (13 mmHg). Patient’s symptoms impoved, and electcardiograph showed that atrial ventricular block and ventricular arrhythmias didn’t occurred anymore. In conclution,PTSMA is effective in reducing the left ventricular outflow tract pressure gradient in this patient with HOCM. However, it resulted severe arrthymias such as complete AV-block and ventricular electrical storm. In this case we found that esmolol is rather effective than lidocaine and amiodarone in the treatment of ventricular electrical storm.

关键词： hypertrophic obstructive cardiomyopathy Percutaneous transluminal septal myocardial ablation atrial-ventricular block electrical storm

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