肥厚型梗阻性心肌病化学消融术.ppt

In-hospital death Complete heart block ventricular fibrillation Acute mitral regurgitation Right bundle branch block perforation PTSMA Complications Procedure-related mortality is around 1% to 2% at experienced centers Septal Myocardial infarction encompassing up to 10% of the overall LV mass Ventricular arrhythmias occur in 5% of patients during hospitalization Persistent completeAV block, with 10% to 20% , requiring a PPM Complications（研究资料） Complication n Rate(%) transitory heart block 123 40.0 Communication branch open 13 4.2 VF 7 2.2 Delay CHB 6 1.9 Death 4 1.3 PPM 2 0.6 Cardiac tamponade 2 0.6 Cardiac rupture 1 0.3 Fuwai Hospital Data(n=310) Complication related to alcohol ablation Long-term Outcomes of?PTSMA for HOCM N(例) 1年生存率 2年生存率 5年生存率 Sedehi D (1972-2006) 52 97.8% 94.7% Fu wai (2005-2013) 227 99.6% 96.9% Sedehi D, Finocchiaro G,?Tibayan Y J Cardiol.2014 Sep 17 肥厚性梗阻型心肌病化学消融远期疗效（n=227） 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 严密心电监测 术中心肌声学造影 严格控制注入酒精总量和速度 每次酒精注入后透视观察 出现III°AVB后酌情使用糖皮质激素 预防并发症的措施 化学消融术是治疗HOCM的有效微创方法 具有经验的中心疗效和外科切除术相当 具有风险，需要严密监测和预防并发症的发生 总结 谢谢大家！ * LVOTPG How to reduce the hypertrophy? Septal myectomy PTSMA 药物 外科切除 经皮室间隔化学消融术（PTSMA) 双强起搏器 HCOM治疗 Intracoronary ethyl?alcohol?or phenol injection ablates aconitine-induced ventricular tachycardia in dogs Chemical ablation by subendocardial?injection? of?ethanol?via catheter--preliminary results in the?pig?heart. Conclusion: Intracoronary?ethanol?ablation is a promising technique for the treatment of arrhythmias. Significant arrhythmias and a decrease in left ventricular ejection fraction are associated with this technique. Alcohol Septal Ablation (SAS) , Inoue H et al,J Am Coll Cardiol. 1987 Dec;10(6):1342-9 Weismüller P et al. Eur Heart J.1991 Nov;12(11):1234-9 Intracoronary?ethanol?ablation in?swine: characterization of myocardial injury in target and remote vascular beds Conclusion: Intracoro