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首页> 外文期刊>Echo Research and Practice >Intervention in HCM: patient selection, procedural approach and emerging techniques in alcohol septal ablation
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Intervention in HCM: patient selection, procedural approach and emerging techniques in alcohol septal ablation

机译：HCM的干预：酒精中隔消融的患者选择，程序方法和新兴技术

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Hypertrophic cardiomyopathy (HCM) is a highly heterogeneous disease with varied patterns of hypertrophy. Basal septal hypertrophy and systolic anterior motion (SAM) of the mitral valve (MV) are the key pathophysiological components to left ventricular outflow tract (LVOT) obstruction in HCM. LVOT is associated with higher morbidity and mortality in patients with HCM. Percutaneous septal reduction therapy with alcohol septal ablation (ASA) can lead to a significant improvement in left ventricle haemodynamics, patient symptoms and perhaps prognosis. ASA delivers pure alcohol to an area of myocardium via septal coronary arteries; this creates damage to tissue akin to a myocardial infarction. The basal septal myocardium involved in SAM–septal contact is the target for this iatrogenic infarct. Appropriate patient selection and accurate delivery of alcohol are critical to safe and effective ASA. Securing the correct diagnosis and ensuring suitable cardiac anatomy are essential before considering ASA. Pre-procedural planning and intra-procedural imaging guidance are important to delivering precise damage to the desired area. The procedure is performed worldwide and is generally safe; the need for a pacemaker is the most prominent complication. It is successful in the majority of patients but room for improvement exists. New techniques have been proposed to perform percutaneous septal reduction. We present a review of the relevant pathophysiology, current methods and a summary of available evidence for ASA. We also provide a glimpse into emerging techniques to deliver percutaneous septal reduction therapy.
机译：肥厚型心肌病（HCM）是一种高度异质的疾病，具有肥大的多种模式。二尖瓣（MV）的基底间隔肥大和收缩前移（SAM）是导致HCM左心室流出道（LVOT）阻塞的关键病理生理成分。 LVOT与HCM患者较高的发病率和死亡率相关。酒精中隔消融术（ASA）进行经皮中隔复位治疗可显着改善左心室血流动力学，患者症状以及预后。 ASA通过间隔冠状动脉将纯酒精输送到心肌区域。这会对组织造成类似于心肌梗塞的损害。参与SAM-中隔接触的基底间隔心肌是该医源性梗塞的靶标。正确的患者选择和准确的酒精输送对于安全有效的ASA至关重要。在考虑使用ASA之前，确保正确的诊断和确保合适的心脏解剖结构至关重要。术前计划和术中成像指导对于将精确的损伤传递到所需区域非常重要。该程序在全球范围内执行，通常是安全的;对起搏器的需求是最突出的并发症。它在大多数患者中都是成功的，但仍有改善的空间。已经提出了新的技术来进行经皮隔隔复位。我们介绍了相关的病理生理学，当前的方法和ASA的现有证据的摘要。我们还提供了一些新兴技术，以进行经皮间隔复位治疗。

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