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CZECH MEDICAL ASSOCIATION J. Ev. PURKYNĚ |
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Česky / Czech version | Vnitř. Lék., 47, 2001, No. 7, p. 437-443 |
Percutaneous Transluminal Septal Myocardial Ablation in the Treatment of Hypertrophic Obstructive Cardiomyopat-
hy: Short-term Follow-up Veselka J., Tesař D., Urbanová T., Telekes P., Honěk T., Neuwirth J. Oddělení srdeční chirurgie Fakultní nemocnice v Motole, Praha, přednosta doc. MUDr. T. Honěk, CSc. Klinika zobrazovacích metod 2. Lékařské fakulty UK a Fakultní nemocnice v Motole, Praha, přednosta doc. Dr. J. Neuwirth, CSc. |
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Summary: In 18 patients with symptomatic hypertrophic obstructive cardiomyopathy 18 procedures involving percutaneous transluminal myocardial ablation were performed. The patients were followed
up for three months after the procedure. The mean intraventricular peak gradient declined
during the intervention from 51 ± 26 mm Hg to 11± 12.2 mm Hg (p < 0.00l). On average 2.7 ± 1.1 ml
ethanol were administered , as a rule into the first septal branch.The target artery was detected
in 13 instances by means of myocardial contrast echocardiography and in five instances by
haemodynamic investigation. In one instance the procedure was combined with subsequent balloon angioplasty of the ramus circumflexus. In one patient it was necessary to implant ex post
a permanent pacemaker on account of AV bloc grade III.In one instance when myocardial contrast echocardiography was not used) infarsation not only of the basal interventricular septum
occurrd but also of the posterolateral left ventricular wall.
During the three-month follow up the incidence of stenocardias assessed according to CCS declined from grade 2.6±0.8 to 0.8 ± 0.8 (p < 0.0001). Dyspnoea evaluated according to NYHA declined
from grade 2.9 ± 0.5 to 1.4±0.6 (p < 0.0001). The maximal intraventricular gradient evaluated by
Doppler echocardiography declined from 57.2 ± 42 mm Hg before the procedure to 19.7 ± 12 mm
Hg(p < 0.001).An identical gradient after stimulation with one dose of isosorbide dinitrate spray
(1.25 mg) declined from 82.3 ± 27 mm Hg to 25 ± 6 mm Hg (p < 0.0001). The diastolic thicknes of the
IVS in the intervened segment declined from 21.2 ± 3 mm to 14.7 ± 2 mm (p < 0.0001). No significant change in the size of the left ventricle was recorded ,nor in its ejection fraction and size of
the left atrium.One patient died suddenly during the follow up period.
Percutaneous transluminal septal myocardial ablation leads during short-term follow-up to a significant weakening of the basal segment of the interventricular septum, a decline of the intraventricular gradient and symptomatology of hypertrophic obstructive cardiomyopathy.
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