经皮间隔心肌消融术治疗3例肥厚型梗阻性心肌病  

Treatment for hypertrophic obstructive cardiomyopathy by percutaneous transluminal septal myocardial ablation

作　　者：胡厚源[1] 何国祥[1] 周林[2] 张萍[3] 李锐[3] 宋治远[4] 史光鉴[4] 

机构地区：[1]第三军医大学西南医院心血管内科重庆市介入心脏病学研究所,重庆400038 [2]第三军医大学科研部,重庆400038 [3]第三军医大学西南医院超声影像诊断科,重庆400038 [4]第三军医大学西南医院心血管内科

出　　处：《第三军医大学学报》2004年第11期1002-1004,共3页Journal of Third Military Medical University

摘　　要：目的　评价经皮经腔间隔心肌消融术 (percutaneoustransluminalseptalmyocardialablation ,PTSMA)治疗肥厚型梗阻性心肌病 (hypertrophicobstructivecardiomyopathy ,HOCM )的即刻和近期疗效 ,并探讨相关并发症的防治。方法　对 3例药物治疗效果不佳的HOCM患者 ,进行经皮经腔间隔心肌消融术治疗 ,由压力监测判断即刻疗效 ,术后半年则由患者临床症状及超声心动图评价近期疗效。结果　室性早搏激发的左室流出道压力阶差术前平均 14 3mmHg ( 70～ 180mmHg) ,术后平均 5 3mmHg ( 3 0～ 80mmHg) ,下降幅度平均 78%( 69%～ 85 %)。 3例中有 1例出现完全性房室传导阻滞伴交界性逸搏心律 ,另有 1例出现完全性右束支传导阻滞。 3例均于术后 6个月随访 ,其心绞痛症状基本消失 ,心功能明显改善 ,室间隔肥厚和SAM现象明显减轻。结论　对于药物治疗效果不佳的HOCM患者 ,可采用PTSMA 。Objective To evaluate the immediate and short term therapeutic efficacy of percutaneous transluminal septal myocardial ablation (PTSMA) in patients with hypertrophic obstructive cardiomyopathy (HOCM) and to investigate the prevention of the related complications. Methods PTSMA was conducted in 3 patients with HOCM refractory to medication. The immediate effect was evaluated by pressure monitor, but the follow up effect by observation of the clinical symptoms and ultrasonic cardiogram. Results The left ventricular outflow tract gradients triggered by ventricular premature beats decreased from 143 mmHg (ranging from 70 to 180 mmHg) to 53 mmHg (ranging from 30 to 80 mmHg). Complete atrioventricular block (Ⅲ°AVB) with atrioventricular node rhythm was found in 1 case, and complete right branch bundle block (CRBBB) in another one. Follow up of the 3 cases at 6 months after operation revealed remarkable improvement of the patients' cardiac function (NYHA), disappearance of angina pectoris, and obvious attenuation of ventricular septal hypertrophy and SAM (systolic anterior motion of mitral) phenomenon. Conclusion PTSMA is an effective method with satisfactory short term effect for the patients with HOCM refractory to medication.

关 键 词：导管消融术 肥厚型心肌病 心律失常 

分 类 号：R540.46[医药卫生—心血管疾病] R542.205[医药卫生—内科学]