经皮室间隔化学消融术对梗阻性肥厚型心肌病二尖瓣反流的影响  

Effect of percutaneous transluminal septal myocardial ablation for mitral regurgitation in hypertrophic obstructive cardiomyopathy

作　　者：黄燕莹[1,2] 费洪文[1,2] 侯跃双[1,2] 许燕[1,2] 李光[1,2] 倪忠涵[1,2] 

机构地区：[1]广东省心血管病研究所心内科 [2]广东省人民医院广东省医学科学院,广州510100

出　　处：《岭南心血管病杂志》2012年第6期612-615,共4页South China Journal of Cardiovascular Diseases

基　　金：广东省医学科研基金(项目编号:A2009044)

摘　　要：目的评价经皮室间隔化学消融术对梗阻性肥厚型心肌病二尖瓣反流的影响。方法选择2007年3月至2012年2月在广东省人民医院诊断为梗阻性肥厚型心肌病的患者41例为研究对象,年龄(51.1±2.2)岁,其中男20例,女21例。利用Sigward法行经皮室间隔化学消融术,浓度99%的无水酒精注入冠状动脉间隔支内,记录术前、术后左心室流出道压力阶差的变化,消融术前及术后第一天通过超声心动图测量左心室流出道压差及二尖瓣反流面积变化。结果导管法术前、术后左心室流出道压力阶差分别为(101.9±33.9)mm Hg(1 mm Hg=0.133 kPa)和(54.3±34.7)mm Hg,两者比较差异有统计学意义(P<0.01)。术前、术后二尖瓣反流面积分别为(7.2±2.1)cm2和(4.0±3.0)cm2,两者比较差异有统计学意义(P<0.01)。线性相关回归分析显示,术前、术后二尖瓣反流面积的变化与左心室流出道压力阶差变化相关(r=0.589,P<0.01)。结论经皮室间隔化学消融术可以降低梗阻性肥厚型心肌病患者左心室流出道压力阶差,使二尖瓣收缩期前向运动减轻,二尖瓣反流减少;二尖瓣反流的减少可以作为评价经皮冠状动脉室间隔化学消融术疗效的指标之一。Ojectives To evaluate the effect of percutaneous transluminal septal myocardial ablation （PTSMA） for mitral regurgitation （MR） in hypertrophic obstructive cardiomyopathy （HOCM）. Methods Totally 41 patients diagnosed as HOCM in Guangdong General Hospital from March 2007 to February 2012 were selected to undergo PTSMA by Sigward method （mean age 51.1±2.2, 20 males, 21 females）. The change of left ventricular outflow tract gradient was monitored before and after septal branch occluded by 99% alcohol. The area of MR was measured before and on the day after PTSMA by transthoracic echocardiography. Results Mean left ventricular outflow tract pressure gradients before and after PTSMA were （101.9±33.9） mm Hg and （54.3±34.7） mm Hg （1 mm Hg=0.133 kPa）, and the difference was statistically significant （P〈0.01）. Mean areas of MR before and on the day after PTAMA were （7.2±2.1） cm2 and （4.0±3.0） cm2, and the difference was also statistically significant （P〈0.01）. Linear correlation and regression analysis showed that the change of MR area was correlated to the change of left ventricular outflow tract pressure gradient （r=0.589, P〈0.01）. Conclusions PTSMA can reduce left ventricular outflow tract pressure gradient in patients with HOCM, relieve systolic anterior motion, and as a result MR can be reduced. Meanwhile, reduction of MR can be considered as one of the indicators of evaluation of PTSMA.

关 键 词：心肌病 肥厚性 二尖瓣反流 经皮室间隔化学消融术 

分 类 号：R542.2[医药卫生—心血管疾病]