经皮腔内室间隔心肌消融术治疗梗阻性肥厚型心肌病57例  

Percutaneous transluminal septal myocardial ablation for hypertrophic obstructive cardiomyopathy

作　　者：王人彭[1] 万海燕[1] 苏骕 马小静[1] 彭剑[1] 宋丹[1] 陈国洪[1] 朱汉东[1] 朱国英[1] 

机构地区：[1]武汉亚洲心脏病医院

出　　处：《中国介入心脏病学杂志》2006年第2期111-114,共4页Chinese Journal of Interventional Cardiology

摘　　要：目的 探讨经皮腔内室间隔心肌消融术治疗梗阻性肥厚型心肌病的方法和疗效.方法 自1999年9月至2005年1月利用Sigwart法为57例梗阻性肥厚型心肌病患者行经皮腔内室间隔心肌消融术治疗.在压力监测、超声应用、消融操作、疗效判定以及术后处理等方面做了一些改进.结果 每例患者消融共用无水乙醇0.6～9.0 mL,分别消融1～5根前间隔支血管;57例患者导管测压示左心室流出道压差（静息和激发）均较术前下降＞50%.发射计算机体层摄影对照4例中2例出现室间隔心肌放射性缺损.随访2周到5年,54例患者晕厥、头晕、心绞痛、心悸、气喘等症状消失或较术前改善;2例症状复发,心脏超声各项指标接近术前;1例术后半年内症状及心脏超声各项指标改善满意,一年半后死于扩张型心肌病.症状改善的54例中术后43例进行了半年、34例进行了1年的心脏超声随访,各项指标较术后2周时进一步改善.术中部分患者出现一过性短暂阵发性室性心动过速、房室传导阻滞.4例心电图呈前间隔心肌梗死改变,其中1例伴下壁心肌梗死改变.结论 经皮腔内室间隔心肌消融术治疗梗阻性肥厚型心肌病疗效显著.本研究对该疗法应用进行了探索,促使经皮腔内室间隔心肌消融术更趋完善.Objective To investigate the effectiveness and methodology of percutaneous transluminal septal myocardial ablation （FISMA）. for hypertrophic obstructive cardiomyopathy （HOCM）. Methods FISMA with Sigwart＇s Method were performed in 57 patients with symptomatic HOCM from September 1999 to January 2005. Improvements were made about pressure monitoring, echocardiography guiding, the ablation procedure and the evaluation criteria of the operation. Results About 0.6 - 9.0 mL of absolute alcohol were consumed during FTSMA in each patient with 1 - 5 target septat branchs ablated per case. 3he resting and provoked left ventricular outflow tract pressure gradient monitored by catheter was reduced over 50% compared with preoperation level in all 57 cases. Two out of four cases with ECT exam had septal myocardial radioactive absence. During the follow-up of 2 weeks to 5 years, the clinical symptoms such as syncope, diziness, angina, palpitation and dyspnea, disappeared or were relieved in 54 cases compared with preoperation status. Two cases regained the above symptoms not long after the operation. One patient showed improvement in clinical symptoms and echocardiographic examination in 6 monthes, but she died of dilated congestive cardiomyopathy at 18 monthes after FTSMA. Follow- up echocardiographic examination was completed in 43 cases at 6 monthes and in 34 cases at 12 monthes after FTSMA. Further improvement was shown on UCG compared with 2 weeks after the operation. Some patients had transient or nonsustained ventricular tachycardia and atrioventricular block. Anteroseptat myocardial infarction was observed in 4 patients and 1 of them was accompanied by inferior myocardial infarction. Conclusion Percutaneous transluminal septal myocardial ablation for hypertrophic obstructive cardiomyopathy is safe and effective. Improvements have to be made for more satisfactory results of FTSMA.

关 键 词：心肌病 肥厚性 心肌消融 

分 类 号：R542.22[医药卫生—心血管疾病] R542.2[医药卫生—内科学]