Abstract
Objective To evaluate the effect of percutaneous transluminal septal myocardial ablation (PTSMA) in patients with hypertrophic obstructive cardiomyopathy (HOCM) and the change of left atrial volume after PTSMA by three-dimensional echocardiography (3DE). Methods Thirty-four patients with HOCM were enrolled in this study. Echocardiography was done at 1 week before PTSMA, 1 week and 1 year after PTSMA. Left ventricular end-diastolic diameter (LVd), 1eft atrial diameter (LAd), interventricular septal thickness (IVSd), 1eft ventricular posterior wall thickness (LVPWd), 1eft ventricular ejection fraction (LVEF) and left ventricular outflow tract peak gradient (LVOT-PG) etc. were acquired by conventional echocardiography. Time-volume curve of left atrium was acquired by 3DE. Left atrial maximal volume (LAVmax), 1eft atrial minimal volume (LAVmin) and 1eft atrial pre-systolic volume (LAVp) were acquaired. Left atrium emptying fraction (LAEF), left atrium passive emptying fraction (LAPEF), left atrium active emptying fraction (LAAEF) and left atrial expansion index (LAEI) were calculated. Comparative analysis was done between before and after PTSMA. Results Compared with pre-procedure, LVOT-PG (54.5±34.5) mmHg (1 mmHg=0.133 kPa), LVEF (71.4±5.7)%, LAVmax (90.2±36.5) ml, LAVp (73.0±34.0) ml and LAVmin (53.2±28.8) ml decreased significantly (t=4.002, 3.234, 3.502, 3.611, 2.253, P<0.05) at 1 week after PTSMA; LVOT-PG (38.3±31.7) mmHg, IVSd (16.7±8.3) mm, LVPWd (11.0±1.9) mm, E/e′ 12.0±4.6, LAVmax (80.9±24.8)ml, LAVp (61.3±23.1) ml, LAVmin (42.6±19.5)ml, MI (1.46±1.06) decreased significantly (t=5.371, 4.165, 3.473, 3.940, 3.655, 4.046, 4.046, z=-2.873, P<0.01), but LAPEF (25.1±5.1)% increased significantly (t=-3.270, P<0.01) at 1 year after PTSMA. Compared with 1 week follow-up, LVOT-PG, IVSd, LVPWd, LAVmax, LAVp, LAVmin, MI decreased significantly (t=2.256, 5.067, 3.137, 2.200, 2.740, 2.016, Z=-2.003, P<0.05), but LVd (41.6±4.0) mm, LAEF (48.3±7.9)% and LAPEF increased significantly (t=-2.288, -2.725, -2.907, P<0.05) at 1 year follow-up. Conclusions For the patients with HOCM after PTSMA, left ventricular outflow tract obstruction relieved, left ventricular filling pressure decreased, and mitral regurgitation improved. 3DE is more accurate and sensitive than two-dimensional echocardiography to evaluate left atrial size. For the patients with HOCM after PTSMA, left atrial volume decreased progressively. Key words: Echocardiography; Cardiomyopathy, hypertrophic; Ventricular function, left; Percutaneous transluminal septal myocardial ablation
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