经皮经腔室间隔化学消融术治疗肥厚型梗阻性心肌病近期疗效观察  

Short-term efficacy of percutaneous transluminal septal myocardial ablation on hypertrophic obstructive cardiomyopathy

作　　者：胡江飚[1] 傅国胜[1] 徐耕[1] 游向东[1] 马骥[1] 程刚[1] 单江[1] 

机构地区：[1]浙江大学医学院附属第二医院心内科

出　　处：《临床心血管病杂志》2005年第2期71-73,共3页Journal of Clinical Cardiology

摘　　要：目的:观察经皮经腔室间隔(IVS)化学消融术(PTSMA)治疗肥厚型梗阻性心肌病(HOCM)的近期疗效。方法:利用 Sigwart法行 PTSMA治疗 HOCM25 例,术前后记录左室血流动力学变化、心电图变化;消融前及术后1个月通过超声心动图测量 IVS 厚度及左室流出道压力阶差(LVOTG)。结果:术后即刻,静息时LVOTG由(72.6±25.9)mmHg(1 mmHg=0.133 kPa)降至(21.8±7.4)mmHg,主动脉收缩压由(120.5±7.1)mmHg升至(140.8±8.2)mmHg,主动脉舒张压由(68.5±6.8)mmHg升至(79.3±7.5)mmHg,冠状动脉舒张期灌注压由(44.1±6.0)mmHg升至(55.7±7.3)mmHg,差异有统计学意义(均P<0.05)。超声心动图测量,术前IVS平均厚度为(23.2±3.7)mm,术后1 个月为(21.6±3.8)mm;术前 LVOTG为 (74.6±28.8)mmHg, 术后 1个月为(18.0±6.2)mmHg(均P<0.05)。术前心功能(NYHA分级)(3.1±0.4)级,术后 1 个月提高到(1.8±0.5)级。术后有永久性完全性右束支传导阻滞 5 例,完全性左束支传导阻滞 1 例。结论:PTSMA能显著降低LVOTG,提高冠状动脉灌注压,改善症状,治疗HOCM近期疗效可靠。Objective:To evaluate the short-term efficacy of percutaneous transluminal septal myocardial ablation(PTSMA) on hypertrophic obstructive cardiomyopathy(HOCM). Method:Twenty-five patients with HOCM underwent PTSMA by Sigward method. The changes of left ventricular hemodynamics and EKG were measured before and after septal branches occluded by 96%~99% alcohol. The thickness of interventricular septum(IVS) and the left ventricular outflow tract gradient(LVOTG) were also measured by echocardiographic examination before and one month after procedure. Result:Immediately after PTSMA,the LVOTG reduced from ( 72.6± 25.9)mmHg to ( 21.8± 7.4)mmHg at rest. The aortic systolic pressure increased from ( 120.5± 7.1)mmHg to ( 140.8± 8.2)mmHg. The aortic diastolic pressure increased from ( 68.5± 6.8)mmHg to ( 79.3± 7.5)mmHg. The diastolic perfusion pressure in the coronary circulation increased from ( 44.1± 6.0)mmHg to ( 55.7± 7.3)mmHg (all P< 0.05). One month after PTSMA,the thickness of IVS reduced from ( 23.2± 3.7)mm to ( 21.6± 3.8)mm,and LOVTG reduced from ( 74.6± 28.8)mmHg to ( 18.0± 6.2)mmHg by echocardiographic examination. NYHA function class improved from ( 3.1± 0.4 ) to ( 1.8± 0.6). Five patients presented with permanent complete right branch conduction block, one with permanent complete left branch conduction block.Complete heart block, posterior or anterior wall myocardial infartion were not observed in all patients after procedure. Conclusion:PTSMA can significantly reduce LVOTG,increase the diastolic perfusion pressure in the coronary circulation, relieve the restrictive symptoms,and has a satisfactory short-term efficacy in the treatment of HOCM.

关 键 词：心肌病 肥厚型 经皮室间隔消融术 

分 类 号：R542.2[医药卫生—心血管疾病]