ABC | Volume 112, Nº4, April 2019

Original Article Yang Li Risk factors for PTSMA complications Arq Bras Cardiol. 2019; 112(4):432-438 Figure 1 – Flow diagram of the patients selection. Pacientes elegíveis (n = 319) Pacientes potencialmente relevantes (n = 258) Pacientes inscritos para análise final (n = 224) 61 não atenderam aos critérios de inclusão 34 foram excluídos: hipertrofia decorrente de outras causas (n = 17); história de infarto do miocárdio (n = 10); intervenção anterior com PTSMA (n = 7) Table 1 – Clinical characteristic of 224 patients with hypertrophic obstructive cardiomyopathy (HOCM) on admission Patients on admission (n = 224) Age (years) 48.20 ± 14.34 Male/female 120/104 New York Heart Association functional class 1.08 ± 0.36 CAD 13 Hypertension 47 DM 3 Stroke 1/ HR (beats/min) 70.92 ± 11.66 LVOTD (mm) 9.38 ± 2.52 EF 0.65 ± 0.07 CAD: coronary artery disease; DM: diabetes mellitus; HR: heart rate; LVOTD: left ventricular outflow tract diameter; EF: ejection fraction. re‑intervention due to the absence of clinical improvement, or recurrence of symptoms, and significant LVOTG. To analyze the influence of the learning curve in relation to PTSMA complications, patients were separated into three chronological groups (early experience: from 2000 to 2004; intermediate experience: from 2005 to 2009; late experience: from 2010 to 2013) according to their experience with PTSMA. Statistical analysis All data analysis was performed with the SPSS System (version 19.0; SPSS Inc., Chicago, IL, USA).One-Sample Kolmogorov-Smirnov test, and Levene’s test had been used to test the normality distribution and variances equality of data. Data with normal distribution were expressed as mean ± standard deviation (SD). Differences between groups were analyzed for statistical significance using the unpaired Student’s t-test. Frequency was compared using Chi-squared (X 2 ) test. Multivariate stepwise logistic regression was used to select independent variables. A p-value < 0.05 (2-tailed) was considered statistically significant. Results A total of 224 subjects, who were between 9-82 years old, were included into this study for final analysis (Figure 1). The detailed patients’ demographic and echocardiographic characteristics were shown in Table 1. Acute results Changes to hemodynamic results during the intervention An 82 year-old patient died during the injection of alcohol for acute pericardial tamponade. A mean of 1.17 ± 0.45 (range: 1-2) septal branches were occluded by injection of 2.07 ± 0.89 ml (range: 0.5-3.0 ml) of alcohol. A reduction in LVOTGwas achieved for all patients. The mean systolic pressure difference in LVOTG at rest decreased from 67.91 ± 37.23 to 16.24 ± 19.13 (p < 0.01). The post premature gradient was reduced from 119.42 ± 38.44 to 40.83 ± 22.61 (p < 0.01). Improvement of clinical course All patients complained of marked chest pain during alcohol injection, and a feeling of discomfort in the left thorax lasted up to 30 hours (10-30 hours). Clinical symptoms greatly improved in 190 patients (85%). Differences in New York Heart Association functional class (from 1.08 ± 0.36 to 1.01 ± 0.09) were not statistically significant. Complications Two patients developed ventricular fibrillation after alcohol injection, and sinus rhythmwas restored by 200 J of defibrillation. Two patients had cardiac shock due to the prolonged occlusion of the septal arteries. One case of thrombosis in the left anterior descending artery during the PTSMA procedure was observed. The patient was successfully treated, and coronary flows were normalized. Temporary right bundle branch block and left bundle branch block occurred in 32 patients and two patients, respectively. Furthermore, 20 patients developed a third-degree AV block, but only four patients developed a complete AV block, requiring PPM implantation. Puncture related complications occurred in four patients (femoral artery pseudoaneurysm in two patients and puncture hematoma in two patients), which were successfully treated with compression bandage. One-year noninvasive follow-up None of the patients were lost to follow-up. No other complications or severe major adverse cardiac events 434