经皮间隔心肌消融术治疗肥厚型梗阻性心肌病的长期随访结果  

Percutaneous transluminal septal myocardial ablation in patients with hypertrophic obstructive cardiomyopathy:immediate and follow-up results

作　　者：吕强[1] 张崟[1] 吴学思[1] 姜腾勇[1] 贾长琪[1] 

机构地区：[1]首都医科大学附属北京安贞医院心内科,北京100029

出　　处：《中国医刊》2005年第7期29-30,共2页Chinese Journal of Medicine

摘　　要：目的评价经皮间隔心肌消融术(PTSMA)治疗肥厚型梗阻性心肌病(HOCM)的长期疗效。方法对于药物治疗仍有症状、心功能(NYHA)Ⅲ-Ⅳ级、静息左室流出道压力阶差(LVOTG)≥30mmHg的HOCM患者施行心肌声学造影指导下的PTSMA,长期随访观察血流动力学、运动耐量及心脏形态学变化的情况。结果共入选23例患者,其中男性12例,女性11例,年龄48.0±14.5岁。本组无死亡病例,无非靶域心肌梗死。28.4±4.0个月(24～36月)后随访,NYHA心功能分级由3.4±0.5改善到1.3±0.5(P<0.001)。超声心动图检查示LVOTG从81.6±25.6mmHg降到27.9±26.5mmHg(P<0.001),73.9%(17/23)的病人LVOTG下降超过50%;室间隔厚度变薄,由术前的23.9±3.7mm降至16.1±3.0mm(P<0.001);左室舒张末内径和收缩末内径分别从术前的39.6±6.4mm,21.8±6.9mm增加到44.3±4.4mm,27.8±4.6mm(P<0.01);左房内径和左室后壁厚度无明显变化。2例(8.7%)因Ⅲ度房室传导阻滞持续不恢复而安装永久起搏器。结论PTSMA能有效降低HOCM患者的LVOTG,改善活动耐量,安全性高。PTSMA可能导致房室传导阻滞而需安装永久起搏器,通过心肌声学造影指导和减缓乙醇注入速度可能会减少危险的发生。Objective To evaluate the immediate and follow - up morphologic, hemodynamic and exercise tolerance results of percutaneous transluminal septal myocardial ablation（PTSMA） in patients with hypertrophic obstructive cardiomyopathy（HOCM）. Methods Between April 1999 and December 2001, twenty - three drug - refractory patients with HOCM,whose left ventricular outflow （LVOT）gradient≥ 30mmHg at rest and New York Heart Association functional class is Ⅲ - IV, underwent PTSMA with application of myocardial contrast echocardiography （MCE） during the procedure. Results No patient died and no severe cardiac complication occurred. LVOT gradient reduction was achieved （ 81.6 ± 25.6mmHg vs 27.9 ± 26.5 mmHg, P 〈 0. 001 ）. During a mean of 28.4 ± 4.0 （ 24 - 36 ） months follow - up, the heart function （NYHA）was greatly improved（3.4 ± 0.5 vs 1.3 ± 0.5, P 〈 0. 001 ）and exercise tolerance increased;the LVOT gradient was reduced significantly （81.6 ± 25.6mmHg vs 27.9 ± 26.5 mmHg, P 〈 0. 001 ） and the septal thicknessdecreased（23.9 ± 3.7mm vsl6.1 ± 3.0mm, P 〈 0. 001 ） examined by echo. Two cases required permanent pacemakerimplantation as Ⅲ °atrial ventricular block lasted for two weeks. Conclusion PTSMA is an effective treatment for drugrefractory patients with HOCM, their symptoms and exercise tolerance was greatly improved. MCE application may behelpful to reduce the complication.

关 键 词：肥厚性心肌病 导管消融术 心肌声学造影 随访研究 

分 类 号：R542.2[医药卫生—心血管疾病]