【Abstract】 Objective To summarize the imaging characteristics of septal branches in hypertrophic obstructive cardiomyopathy and explore the correlation between its classification and myocardial chemical ablation; Methods To classify and compare the number, thickness, and distribution of septal branches in 200 normal coronary artery angiographers and 76 patients with hypertrophic obstructive cardiomyopathy. Results: The morphology of septal branches in hypertrophic obstructive cardiomyopathy was not significantly different from that of normal coronary arteries; the morphology of septal branches determined the choice of myocardial chemical ablation methods, i.e., PTSMA method for type I myocardial chemical ablation, PTSTMA method for type II and type III; Conclusion: The different typing of coronary septal branches determines the choice of procedure in the case of myocardial chemical ablation in hypertrophic obstructive cardiomyopathy. Caring Min, Department of Cardiology, The First Affiliated Hospital of Henan College of Traditional Chinese Medicine The variation and significance on angiography of interventricular septal branches of coronary artery on patients with hypertrophic obstructive cardiomyopathy GUAN Huai-min*, XIE Jin-hong, CHEN Yu-shan, et al. *Department of Cardiology, the First Affiliated Hospital of Henan University of TCM, Zhengzhou, China. Department of Cardiology, the First Affiliated Hospital of Henan University of TCM, Zhengzhou 450000, China Corresponding author:XIE Jin-hong, E-mail:[email protected] 【Abstract】 Objective To summarize the features and clinical significance of cardiomyopathy. summarize the features and clinical significance of angiography about interventricular septal branches of coronary artery on patients with HOCM. Methods We classified and compared the image features of interventricular septal branches from 200 normal persons and 76 cases HOCM, such as: amount, dimensions and distribution. Methods We classified and compared the image features of interventricular septal branches from 200 normal persons and 76 cases HOCM, such as: amount, dimensions and distribution. Results There were no significant differences about the image features of interventricular septal branches between There were no significant differences about the image features of interventricular septal branches between normal persons and HOCM. Conclusion The operation mode choices of percutaneous transluminal septal myocardial ablation (PTSMA) should rely on the different image features of interventricular septal branches. Conclusion The operation mode choices of percutaneous transluminal septal myocardial ablation (PTSMA) should rely on the different image features of interventricular septal branches. Hypertrophic obstructive cardiomyopathy; Interventricular septal branches; Percutaneous transluminal septal myocardial ablation With the popularization of septal septal myocardial chemoablation (PTSMA) in hypertrophic obstructive cardiomyopathy (HOCM), its complementary technique, septal tunneling myocardial ablation (STMA), has become more popular. Tunnel myocardial chemical ablation (PTSTMA), doctors want to know more about the distribution, thickness and length of the coronary septal branches, because the different morphology is directly related to the indications for HOCM, the choice of surgical modality and the success rate of the procedure [1-3], for this reason, we reviewed the coronary angiography septal branch imaging data of patients with non-coronary artery disease (NCA) and hypertrophic obstructive cardiomyopathy (HOCM) in the last few years, to find its pattern and to explore its division. In order to find its pattern and explore the correlation between its typing and myocardial chemical ablation. 1 Objects and methods 1.1 Subjects 200 patients, 127 males and 73 females, aged 34-75 (46.2±15.4) years, with nonspecific symptoms such as panic and chest tightness and normal coronary artery imaging were selected from June 2005 to June 2011, and about half of them had one or two risk factors for coronary artery disease in combination with one or two risk factors for coronary artery disease. other organic heart diseases were excluded, and the other patients who had invasive left ventricular- aortic root thrombosis (LVART) were excluded. There were 76 patients diagnosed with HOCM by invasive left ventricular-aortic root differential pressure measurement, 54 males and 22 females, aged 34-62 (48±16) years, all of whom were treated with septal chemical ablation.There were also 29 patients diagnosed with hypertrophic cardiomyopathy and confirmed to have nonobstructive cardiomyopathy by invasive differential pressure measurement in the same period, 18 males and 11 females, aged 36-66 years ( 45.7±14.6) years old, and were treated clinically with pharmacologic conservative therapy. All patients with cardiomyopathy were routinely subjected to coronary angiography while having left ventricular-aortic root differential pressure measurement; those with combined coronary artery disease or coronary artery malformation were excluded. 1.2 Methods Coronary arteriography was used for morphologic typing based on the frequency of repetitions of the septal branch imaging pattern. Coronary artery angiography was performed by radial or femoral artery approach, and Judikin’s method was used to perform coronary artery angiography, during which 3000 units of common heparin was given in the arterial sheath, and left and right side coronary artery angiography was routinely performed, and the proximal segment of septal branch of anterior descending branch was projected from multiple angles, so that its distribution, shape, thickness, and length could be adequately demonstrated and detailed records were made. The right anterior oblique 20° + head 30° coronary angiography septal branch with the clearest visualization was classified into three types by three experienced coronary interventionalists visually (see the schematic diagram). Among the 200 patients with normal coronary angiograms who were suspected of having coronary artery disease, 132 cases (66% of the total) had type I morphology, 25 cases (12.5% of the total) had type II-A morphology, 19 cases (9.5% of the total) had type II-B morphology, and 24 cases (12% of the total) had type III morphology. The morphology of septal branches on preoperative coronary angiography of HOCM showed that 48 cases, or 63% of the total, conformed to type I morphology, 12 cases, or 16% of the total, conformed to type II-A morphology, 10 cases, or 13% of the total, conformed to type II-B morphology, and 6 cases, or 8% of the total, conformed to type III morphology. Coronary angiography of 29 patients with non-obstructive cardiomyopathy showed interventricular septal branches in 17 cases, accounting for 58.6% of the total number of cases, 7 cases, accounting for 24% of the total number of cases, 7 cases, accounting for 24% of the total number of cases, 5 cases, accounting for 17.4% of the total number of cases, and no cases of type III morphology. 1.3 Statistical methods SPSS 10.0 statistical analysis software was applied, and the measurement data were expressed by -X ±S, t-test or ANOVA; the count data were subjected to the 2 test. P<0.05 was regarded as the difference was statistically significant. 2 Results 2.1 Comparison of HOCM and normal coronary septal branch typing The angiographic morphology of septal branches in HOCM patients did not differ from that of normal coronary arteries, and type I was absolutely dominant (P<0.01). 2.2 Comparison of the morphology of obstructive and non-obstructive interventricular septal branches in hypertrophic cardiomyopathy The interventricular branches of patients with obvious hypertrophy were mostly thicker, but a small number of patients with poor cardiac function even though their hypertrophy was obvious. However, in a few patients, even with obvious hypertrophy, poor cardiac function, and a long history of disease, the septal branches were not thick or even thin, therefore, there was no correlation between the degree of hypertrophy and the morphology of septal branches; and there was no difference in the morphology of septal branches between obstructive and nonobstructive types of hypertrophic cardiomyopathy; see Table 2. 2.3 Morphology of septal branches of HOCM and ablation method The morphology of septal branches determines the choice of myocardial chemical ablation method, and PTSMA method is used in type I, PTSTMA method is used in type II and type III. The PTSMA method was used for type I myocardial ablation, and the PTSTMA method was used for type II and type III. 3 Discussion We chose 200 cases of clinically suspected "coronary artery disease" with normal coronary arteries, aged 36-76 years, of both sexes, in a sense, to provide the morphology of the septal branches of the coronary arteries of the healthy people and their distribution, and to provide the anatomical basis for the reference to the changes of the septal branches of the coronary arteries in other cardiac diseases. Anatomical basis. Of course, these subjects had chest discomfort symptoms, age, gender and other factors are different from the healthy population, so there are limitations in the results In this study, among the 76 patients with HOCM, the three types of septal branches were not significantly different from those in healthy subjects, and it can be said that more than 60% of the patients could be treated by chemical ablation of large septal branches, and the other patients could be treated by ablation of small septal branches. It can be said that more than 60% of patients can be treated by chemical ablation of large septal branches, and others can be treated by ablation of small septal branches. It is worth mentioning that we found that there is a potential correlation between the thickness of the septal arteries in the outflow tract of HOCM and the thickness of the interventricular septum. The smaller the septal branches, the less severe the septal hypertrophy; on the other hand, the larger the septal branches, the more pronounced the interventricular septal hypertrophy. This may be due to local myocardial hyperplasia, which requires increased blood supply and results in compensatory thickening and lengthening of the innervating vessels [4]. However, there are exceptions. In five of these patients, the coronary septal branches of the coronary arteries were shown to be relatively small on imaging, while the ultrasound showed that the septal hypertrophy was quite severe, and the degree of obstruction was not the most severe, accompanied by the weakening of the anterior wall motion, the enlargement of the left atrium, combined with varying degrees of pulmonary hypertension; the electrocardiogram showed the pathologic Q waves from V1 to V3; and the clinical manifestation of obvious signs of cardiac insufficiency, and exertional and prone type dyspnea. This is often a late change of HOCM, suggesting a poor prognosis. this change seems to be contradictory to most of the above conditions, the reason may be: ① myocardial hyperplasia and hypertrophy, the center of the myocardium will undergo degeneration, apoptosis, necrosis and other changes, the need for blood to reduce the blood vessels atrophy accordingly. ② severe hypertrophy of the myocardium on the local arterial vascular compression and contraction of the "myocardial bridge phenomenon", so that the lumen gradually collapsed. With the aggravation of obstruction, the pressure of aortic root decreases, the perfusion pressure of coronary artery decreases, and the blood flow of septal branch decreases. (4) After obstruction, the left ventricular pressure increases dramatically, the pressure difference from epicardium to endocardium decreases, myocardial perfusion decreases, and local ischemia becomes more obvious; at the same time, it also initiates the "stretching reflex" of the left ventricular wall, which makes myocardial contraction weakened [5-7]. This is also a protective mechanism, as a result of which cardiac function is further reduced, the rate of systolic pressure change (dp/dt) of the left ventricle is further weakened, and the left ventricle-aortic root pressure gradient is narrowed, and the obstruction is relatively reduced. In this group of HOCM patients, the septal branches were the most numerous in type I, which were treated by PTSMA, while the proportion of type II and type III was relatively small, which were treated by PTSTMA to achieve satisfactory results. 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