心肌超声造影在肥厚型梗阻性心肌病化学消融术中的应用  

The value of myocardial contrast echocardiography in transcoronary ablation of septal hypertrophy for hypertrophic obstructive cardiomyopathy

作　　者：何怡华[1] 李治安[1] 张烨[1] 陆兆龄[1] 杨娅[1] 

机构地区：[1]首都医科大学附属北京安贞医院超声诊断科,100029

出　　处：《中华医学超声杂志（电子版）》2005年第6期337-339,共3页Chinese Journal of Medical Ultrasound(Electronic Edition)

摘　　要：目的探讨选择性心肌超声造影(MCE)在肥厚型梗阻性心肌病(HOCM)室间隔心肌化学消融术(TASH)中的应用价值。方法对47例HOCM患者在TASH术前应用冠状动脉多普勒血流成像(CDCFI)初步拟定靶血管,并向拟定的靶血管远端在注入造影剂后即刻和注入无水酒精5min后,超声实时监测并观察造影剂显影范围、充盈缺损范围,并对比造影剂显影范围和无水酒精显影范围。结果47例患者中2例因冠状动脉造影显示间隔支分布细小弥漫及2例因CDCFI显示无合适血管,故未行MCE而放弃治疗。余43例实施MCE并行TASH,其中38例成功,38例中4例心肌显影范围略超过靶域,采用缓慢、分次注入无水酒精后,消融成功；另34例心肌造影显影位置与梗阻心肌相吻合；5例MCE指导放弃消融术。近期对10例患者应用MCE的CPS技术,发现9例造影剂显影范围与充盈缺损范围吻合,1例充盈缺损范围明显小于造影剂显影范围,追加消融间隔支,TASH成功。结论MCE可为HOCM患者的TASH术中间隔支靶血管的选择及消融范围的判断提供可靠依据。Objective To evaluate the application of myocardial contrast echocardiography （MCE） with selected target vessel during transcoronary ablation of septal hypertrophy （TASH） for hypertrophic obstructive cardiomyopathy （HOCM）. Methods In 47 HOCM patients, cardiac apex four-chamber view, parasternal left ventricular long-axis view and left ventricular short-axis .view were recorded after the myocardial contrast agents and absolute ethanol （5 min later）, separately, were injected into the selected vessels before TASH. The extent of opacification zones and filling defect were observed. The developing extent of contrast agent was compared with that of absolute ethanol. Results Among 47 patients, 2 gave up treatment because of no appropriate vessel to provide ablation by color Doppler coronary flow imaging （CDCFI） ; another 2 also gave up treatment because of diffused septal branches of coronary arteries on coronary angiography. The remaining 43 patients underwent MCE ; of them, 5 patients gave up TASH, including 1 with opacification of left ventricular mammary muscles, 1 with opacification of right ventricular mammary muscles, 1 with the opacification zone out of the target area and 2 with too large opaciflcation zone. The other 38 patients underwent TASH successfully. Of these 38 patients, 34 had the extent of opacification zones in correspondence with the infracted myocardium ; while 4 had the extent of opacification zones exceeding the target region, thus slow and fractional injection of absolute ethanol was done in them with successful results. Recently, using MCE-CPS in 10 patients, we found that the extent of opacification zone coincided with the extent of filling defect in 9, while the extent of filling defect was obviously smaller than that of the opacification zone in 1, then timely remedy by TASH was done successfully. Conclusions MCE is reliable for selecting the target vessels and defining the ablation extent in TASH for patients with HOCM.

关 键 词：超声心动描记术 造影剂 肥大性心肌病 导管消融术 肥厚型梗阻性心肌病 化学消融术 

分 类 号：R542.2[医药卫生—心血管疾病]