Hipertrofik obstrüktif kardiyomiyopatide septal alkol ablasyonu: Retrospektif bir inceleme
Küçük Resim Yok
Tarih
2012
Dergi Başlığı
Dergi ISSN
Cilt Başlığı
Yayıncı
Erişim Hakkı
info:eu-repo/semantics/openAccess
Özet
Amaç: Bu çalışmada semptomatik hipertrofik obstrüktif kardiyomiyopati (HOKM) nedeniyle septal alkol ablasyonu (SAA) uygulanan olguların erken ve geç dönem sonuçları değerlendirildi. Çalışma planı: Ocak 2005 - Kasım 2011 tarihleri arasında kliniğimizde medikal tedaviye dirençli semptomatik HOKM nedeniyle SAA uygulanan 15 hasta (9 erkek, 6 kadın; ort. yaş 53±14 yıl; dağılım 23-81 years) retrospektif olarak incelendi. Tüm olgulara perkütan olarak sol koroner arter içerisinden septal arter kateterize edilerek kontrast ekokardiyografi kılavuzluğunda uygun hedef bölgeye etil alkol enjeksiyonu yapıldı. Bulgular: İşlem öncesi ortalama fonksiyonel sınıf 3.5±0.5, maksimal sol ventrikül çıkış yolu (SVÇY) gradiyentleri ekokardiyografik olarak 104±25 mmHg, kateterizasyonda 97±25 mmHg ve bazal interventriküler septum kalınlığı 2.3±0.4 cm idi. İşlemin sonrasında SVÇY gradiyentleri ekokardiyografik olarak 35±15 mmHg’ye, kateterizasyonda ise 25±14 mmHg’ye düştü. Bir olguda geçici süreli Wenckebach periyodu bir olguda ise akut atriyal fibrilasyon izlendi. Septal alkol ablasyonundan sonra geçen süre ortalama 1196±675 gündü. Hastaların 6. aydaki ortalama fonksiyonel sınıfları 1.2±0.6 idi. Bir olguya üçüncü yılda tekrarlayan yakınmalar nedeniyle tekrar SAA işlemi yapıldı. İzlem süresi içerisinde bir olgunun işlemden yaklaşık bir yıl sonra kaybedildiği öğrenildi. Başlangıçta üç olguda kardiyak defibrilatör ve bir olguda kalıcı kalp pili mevcut iken, izlem boyunca hiçbir olguya yeni kalp pili takılması gerekmedi. Sonuç: Medikal tedaviye dirençli, semptomatik ve uygun seçilmiş HOKM olgularında, SAA kabul edilebilir bir başarı ve güvenilirlikle uygulanabilir.
Background: This study aims to evaluate early- and late outcomes of alcohol septal ablation (ASS) in symptomatic patients with hypertrophic obstructive cardiomyopathy (HOCM). Methods: Between January 2005 and November 2011, 15 patients (9 males, 6 females; mean age 53±14 years; range 23 to 81 years) who underwent ASS in our clinic due to medically refractory symptomatic HOCM were retrospectively analyzed. In all cases, septal artery was catheterized percutaneously through the left coronary artery and ethyl alcohol was injected to appropriate target site with contrast echocardiographic guidance. Results: The mean preoperative functional class was 3.5±0.5, maximum left ventricular outflow tract (LVOT) gradients were echocardiographically 104±25 mmHg, in catheterization 97±25 mmHg and basal interventricular septal thickness was 2.3±0.4 cm. Following the procedure, LVOT gradients echocardiographically decreased to 35±15 mmHg and in catheterization to 25±14 mmHg. A temporary Wenckebach episode in one case and acute atrial fibrillation in one case were observed. The mean time from ASS was 1196±675 days. At six months, the mean functional class of the patients was 1.2±0.6. One case underwent re-SAA due to recurrent complaints at three years. During the follow-up, one case died within a year following the procedure. At baseline, three cases had cardiac defibrillators and one case had a pacemaker, no case required new pacemaker during the follow-up period. Conclusion: In appropriately selected patients with medically refractory and symptomatic HOCM, ASS can be applied with an acceptable success and reliability.
Background: This study aims to evaluate early- and late outcomes of alcohol septal ablation (ASS) in symptomatic patients with hypertrophic obstructive cardiomyopathy (HOCM). Methods: Between January 2005 and November 2011, 15 patients (9 males, 6 females; mean age 53±14 years; range 23 to 81 years) who underwent ASS in our clinic due to medically refractory symptomatic HOCM were retrospectively analyzed. In all cases, septal artery was catheterized percutaneously through the left coronary artery and ethyl alcohol was injected to appropriate target site with contrast echocardiographic guidance. Results: The mean preoperative functional class was 3.5±0.5, maximum left ventricular outflow tract (LVOT) gradients were echocardiographically 104±25 mmHg, in catheterization 97±25 mmHg and basal interventricular septal thickness was 2.3±0.4 cm. Following the procedure, LVOT gradients echocardiographically decreased to 35±15 mmHg and in catheterization to 25±14 mmHg. A temporary Wenckebach episode in one case and acute atrial fibrillation in one case were observed. The mean time from ASS was 1196±675 days. At six months, the mean functional class of the patients was 1.2±0.6. One case underwent re-SAA due to recurrent complaints at three years. During the follow-up, one case died within a year following the procedure. At baseline, three cases had cardiac defibrillators and one case had a pacemaker, no case required new pacemaker during the follow-up period. Conclusion: In appropriately selected patients with medically refractory and symptomatic HOCM, ASS can be applied with an acceptable success and reliability.
Açıklama
Anahtar Kelimeler
Cerrahi, Kalp ve Kalp Damar Sistemi
Kaynak
Türk Göğüs Kalp Damar Cerrahisi Dergisi
WoS Q Değeri
Scopus Q Değeri
Cilt
20
Sayı
3
