AIMS:Alcohol septal ablation (ASA) is an established treatment option in hypertrophic obstructive cardiomyopathy (HOCM). ASA is ineffective in some: inaccurate infarct and inability to identify a vessel contribute. We aimed to improve accuracy of infarct using CT angiography guidance and provide a more predictable and satisfactory outcome. METHODS AND RESULTS:Twenty-one successive patients with symptomatic LVOT obstruction refractory to medication underwent CT angiography planning to guide ASA. CT was performed using a dual-source CT system. Alcohol was delivered to the artery identified from CT: in 17/21 this was a sub-branch of a septal artery, in 2/21 the septal vessel was identified from the circumflex artery. Peak gradient improved from 98 (IQR 89.50-111.50) mmHg to 14 (IQR 8.50-22) mmHg (p=0.003). Systolic anterior motion (SAM) improved in 18/20 patients. NYHA class improved by ≥1 in 18/20. Peak VO2 improved from 79.19% of predicted value (±14.01) to 91.62% (±12.02) predicted (p<0.0001). Success at the first procedure is greater with CT guidance, 17/20 vs. 50/75 with traditional methods (pre-CT guidance) (p=0.02); 9/20 had six-month CMR with target septum infarct in all. ASA-related RBBB reduced from 62% to 13% (p=0.0004). CONCLUSIONS:CT angiography planning improves localisation of infarct and procedural success at the first attempt in ASA when compared to traditional methods. Follow-up to six months suggests a symptomatic, functional and haemodynamic improvement.

译文

目的:酒精中隔消融(ASA)是肥厚性梗阻性心肌病(HOCM)的既定治疗选择。 ASA在某些方面无效:不正确的梗塞和无法识别血管。我们旨在使用CT血管造影指导提高梗塞的准确性,并提供更可预测和令人满意的结果。
方法和结果:21例因药物难治性LVOT梗阻的连续患者接受了CT血管造影计划,以指导ASA。使用双源CT系统进行CT。酒精被输送至通过CT识别的动脉:在17/21中,这是隔动脉的一个分支,在2/21中,是从回旋支动脉中识别出了间隔血管。峰梯度从98(IQR 89.50-111.50)mmHg提高到14(IQR 8.50-22)mmHg(p = 0.003)。 18/20例患者的收缩前运动(SAM)有所改善。 NYHA等级在18/20中提高了≥1。 VO2峰值从预测值的79.19%(±14.01)提高到预测值的91.62%(±12.02)(p <0.0001)。 CT引导下第一次手术的成功率更高,传统方法为17/20,而传统方法为50/75(CT引导前)(p = 0.02); 9/20进行了为期六个月的CMR,总共有目标隔梗塞。与ASA相关的RBBB从62%降低到13%(p = 0.0004)。
结论:与传统方法相比,CT血管造影规划可在ASA首次尝试时改善梗塞的局限性和手术成功率。六个月的随访表明症状,功能和血流动力学均有改善。

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