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英文誌(2004-)

Journal of Medical Ultrasonics

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2002 - Vol.29

Vol.29 No.05

Case Report(症例報告)

(J463 - J468)

閉塞性肥大型心筋症に対する経皮的中隔心筋焼灼術前後の心エコードプラ所見(長期追跡結果)

Echocardiographic Follow-up Study after Percutaneous Transluminal Septal Myocardial Ablation for Hypertrophic Obstructive Cardiomyopathy

早川 勇樹1, 安 隆則2, 藤井 幹久2, 小塚 裕之1, 梅澤 志寿子1, 笠井 典子1, 湯舟 憲雄1, 久保 典史2, 鮨玖陸 宗靖2

Yûki HAYAKAWA1, Takanori YASU2, Mikihisa FUJII2, Hiroyuki KOTSUKA1, Shizuko UMEZAWA1, Noriko KASAI1, Norio YUBUNE1, Norifumi KUBO2, Muneyasu SAITO2

1自治医科大学附属大宮医療センター生理機能検査, 2自治医科大学附属大宮医療センター循環器科

1Unit of Clinical Physiology, Omiya Medical Center, Jichi Medical School, 2Cardiovascular Division, Omiya Medical Center, Jichi Medical School

キーワード : echocardiography, hypertrophic obstructive cardiomyopathy, percutaneous transluminal septal myocardial ablation

Percutaneous transluminal septal myocardial ablation was introduced as a method for treating symptomatic hypertrophic obstructive cardiomyopathy. Here we explore serial changes in pressure gradient in the left ventricular outflow tract, septal myocardial thickness, and wall motion in patients with hypertrophic obstructive cardiomyopathy before and after percutaneous transluminal septal myocardial ablation was carried out. The subjects consisted of three consecutive patients with symptomatic hypertrophic obstructive cardiomyopathy who underwent percutaneous transluminal septal myocardial ablation. All three patients had pressure gradients greater than 120 mmHg in the left ventricular outflow tract as demonstrated by continuous Doppler echocardiography before ablation. Doppler echocardiography was repeated immediately after and 2, 14, 180, and 540 days after ablation. Pressure gradient in the left ventricular outflow tract decreased abruptly in two patients after ablation, although they showed a transient increase in pressure gradient as a result of myocardial edema two days later. The other patient showed no significant decrease in pressure gradient immediately after percutaneous transluminal septal myocardial ablation but did show a significant decrease 14 days later. Echocardiography 14 days after ablation demonstrated akinesis and wall thinning of the basal septum with high subendocardial echo-intensity. Two patients showed further reduction in the pressure gradient in the left ventricular outflow tract 180 days after the procedure. Symptomatic improvement paralleled a reduction in the pressure gradient in the left ventricular outflow tract. Follow-up study by Doppler echocardiography is highly recommended after percutaneous transluminal septal myocardial ablation, even after a completely successful procedure, because dynamic changes in the left ventricular outflow tract pressure gradient can result from several different cardiac and noncardiac factors.