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1、 Percutaneous Septal Myocardial Ablation (PASMA)Cardiovascular Institute Cardiac contraction strength of oppression the large myocardial coronary artery; Intramyocardial small coronary artery stenosis and intimal thickening abnormalities, leading to cardiac hypertrophy and coronary artery oxygen req
2、uired due to an imbalance of oxygen supply. Arrhythmia and Arrhythmia and sudden death HOCM of patients with abnormal myocardial cells and the arrangement of disorder provides a basis for the arrhythmia. However, abnormal myocardial arrangement and spontaneous arrhythmias and ventricular fibrillatio
3、n threshold, the precise relationship is unclear. About 25% of patients may have non-sustained ventricular tachycardia, the arrhythmia is sudden death of a good predictor, and negative predictive accuracy is 97%. Risk factors for sudden death Risk factors for sudden death High-risk:High-risk: 1 Sudd
4、en death occurred in a successful 1 Sudden death occurred in a successful rescuerescue2 continuous 2 continuous monomorphicmonomorphic ventricular ventricular tachycardiatachycardia Clinical risk factors:Clinical risk factors:1 non-sustained ventricular tachycardia 1 non-sustained ventricular tachyc
5、ardia2 movement abnormal blood pressure 2 movement abnormal blood pressure response ( response ( 25mmHg) 25mmHg)3 unexplained syncope 3 unexplained syncope4 early-onset family history of sudden 4 early-onset family history of sudden deathdeath5 severe left ventricular hypertrophy 5 severe left ventr
6、icular hypertrophy 30mm30mm The purpose of the treatment PTMSA Treatment of symptomatic patients with Treatment of symptomatic patients with HOCM HOCM The PTMSA treatment of HOCM is a obstruction by blocking a the supply blood of parts of the septal hypertrophy of myocardial and myocardial injury in
7、 the region, leading to the area of myocardial necrosis, myocardial contractile function disappeared, Widened the left ventricular outflow tract, while lowering the outflow tract obstruction and the cardiac output increase. And improve clinical symptoms and hemodynamics. PTSMA PTSMA indication indic
8、ation (1) (1)Clinical indicationClinical indication Symptomatic patientsSymptomatic patients Drug refractory severe said effects medical Drug refractory severe said effects medical treatmenttreatment Functional class III or IV Functional class III or IV Functional class II with objective limitation
9、or Functional class II with objective limitation or risk factorsrisk factors Recurrent exercise-induced Recurrent exercise-induced syncopessyncopes Failure of prior Failure of prior myectomymyectomy or DDD-PM or DDD-PM ComorbitiyComorbitiy with increased surgical risk. with increased surgical risk.P
10、TSMA PTSMA indication indication (2) (2)HemodynamicHemodynamic indication in symptomatic patients indication in symptomatic patients The pressure gradient at rest 50mmHg or 100mmHg with provocation. In 2008 ESC meeting, Seggewise that LV gradient LV gradient 3030 mmHg at rest or mmHg at rest or Prov
11、ocableProvocable LV gradient LV gradient 60 60 mmHg. mmHg. ValsalvaValsalva Post Post extrasystoleextrasystole. . No No dobutaminedobutamine gradients (Drugs) gradients (Drugs)( (There is no information that reduce the LVOT pressure to There is no information that reduce the LVOT pressure to reduce
12、sudden death, but the LVOT 30mmHg and increased reduce sudden death, but the LVOT 30mmHg and increased risk of death directly related to, risk of death directly related to, New Eng l J Med 2003; 348:295-303)New Eng l J Med 2003; 348:295-303) Hypertrophic CardiomyopathyHypertrophic CardiomyopathySurv
13、ival According to Outflow Tract GradientSurvival According to Outflow Tract GradientBJ Maron et al; JAMA 281:650-655, 1999PTSMA PTSMA indication indication (3)(3)MorophologicMorophologic indication indication EchocariographyEchocariography SubaorrticSubaorrtic SAM-associated gradient SAM-associated
14、gradient Mid- Mid-cavitarycavitary gradient gradient Caution: papillary muscle involvement: Caution: papillary muscle involvement: MCE MCENo prolonged No prolonged mitralmitral leaflets leaflets Coronary angiographyCoronary angiographysuitable suitable septalseptal branch. branch.Outflow tract obstr
15、uction sign in EchocardiographM-mode echocardiogram in obstructive hypertrophic cardiomyopathy showing systolic anterior motion of the mitral valve (SAM) (arrows indicating septum and mitral valve leaflet contact) MorphologicMorphologic of HOCM of HOCMNew New classficationclassfication of HOCM of HOCM Methods: they were classified Methods: they were classified into 4 types according to the into 4 types according to the echocardiographicechocardiographic results: results: Type IType I :
