russjcardiolРоссийский кардиологический журналRussian Journal of Cardiology1560-40712618-7620«SILICEA-POLIGRAF» LLC10.15829/1560-4071-2017-8-122-127russjcardiol-2449Research ArticleОБЗОРЫ ЛИТЕРАТУРЫREVIEWСПИРТОВАЯ СЕПТАЛЬНАЯ АБЛЯЦИЯ МЕЖЖЕЛУДОЧКОВОЙ ПЕРЕГОРОДКИ С КОНТРАСТНЫМ ЭХОКАРДИОГРАФИЧЕСКИМ КОНТРОЛЕМALCOHOL-BASED SEPTAL ABLATION OF INTERVENTRICULAR SEPTUM WITH CONTRAST ECHOCARDIOGRAPHIC CONTROLОсиевА. Г.OsievA. G.

д-р мед. наук, профессор, руководитель отделения хирургии сердца и сосудов

osiev_ag@mail.ruГегенаваБ. Б.GegenavaB. B.

к.м.н., ст. науч. сотр. кардиохирургического отделения

gegenava_boris@dr.comПалеевФ. Н.PaleevF. N.

директор

filipp@paleev.ruГригорьеваН. М.GrigoryevaN. M.

к.м.н., кардиолог отделения ангиографии

gegenava_boris@dr.comГБУЗ МО МОНИКИ им. М.Ф. ВладимирскогоРоссияMoscow Regional Research and Clinical Institute (MONIKI)Russian Federation20170710201708122127Copyright © Осиев А.Г., Гегенава Б.Б., Палеев Ф.Н., Григорьева Н.М., 20172017Осиев А.Г., Гегенава Б.Б., Палеев Ф.Н., Григорьева Н.М.Osiev A.G., Gegenava B.B., Paleev F.N., Grigoryeva N.M.Данная работа распространяется под лицензией Creative Commons Attribution 4.0.This work is licensed under a Creative Commons Attribution 4.0 License.https://russjcardiol.elpub.ru/jour/article/view/2449

Спиртовая септальная абляция была впервые предложена в 1994 г. в качестве альтернативы хирургической септальной миэктомии у пациентов с обструктивной гипертрофической кардиомиопатией, рефрактерной к медикаментозной терапии. Данная процедура уменьшает симптомы заболевания, образуя целенаправленный, ограниченный инфарктный очаг верхней части межжелудочковой перегородки, что приводит к увеличению диаметра выходного отдела левого желудочка, снижению градиента давления на уровне выходного отдела левого желудочка и регрессу гипертрофии левого желудочка, который был вызван перегрузкой давлением. Подобного улучшения клинических проявлений удается достичь в большинстве случаев. Основное осложнение спиртовой септальной абляции – развитие полной атриовентрикулярной блокады, в связи с чем у некоторых пациентов возникает необходимость установки постоянного кардиостимулятора. Применение эхокардиографии с контрастированием миокарда во время спиртовой септальной абляции позволяет ограничить размер инфаркта миокарда, использовать меньшее количества спирта и, соответственно, уменьшить частоту осложнений.

Alcohol septal ablation was introduced in 1994 as an alternative for surgical septal myectomy in patients with obstructive hypertrophic cardiomyopathy refractory to drug treatment. The procedure decreases symptoms of the disease creating targeted localized infarction focus of the upper part of interventricular spetum leading to increase of outgoing tract diameter, decrease of pressure gradient at the level of outgoing left ventricle tract and hypertrophy regression caused by overload. Such clinical improvement can be achieved in most cases. Main complication of the alcohol-based ablation — complete atrioventricular block with necessity, in some patients, of permanent cardiostimulator. Contrast echocradiography during alcohol septal ablation makes it to localize infarction, to use less amount of alcohol and, therefore, to decrease complications rate.

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The authors declare that there are no conflicts of interest present.