超声心动图监测肥厚梗阻型心肌病经皮冠脉化学消融治疗术的临床意义  

The value of percutaneous transluminal septal myocardial ablation in hypertrophic obstructive cardiomyopathy monitored with echocardiography

作　　者：何亚乐[1] 陈纪言[1] 林曙光[1] 侯跃双[1] 黄新胜[1] 冯碧霞[1] 许燕[1] 李伟茹[1] 

机构地区：[1]广东省心血管病研究所,广州市510080

出　　处：《岭南心血管病杂志》2000年第3期185-187,共3页South China Journal of Cardiovascular Diseases

摘　　要：目的 经皮穿隔支室间隔心肌消融（ＰＴＳＭＡ）是治疗肥厚梗阻型心肌病的新方法，本文目的是报道超声心动图监测ＰＴＳＭＡ的临床价值。方法１例６６岁的男性患者药物治疗效果欠佳接受ＰＴＳＡＭ术，术前、术中、术后行超声监测。结果 消融前导管测左室与流出道的压力差　Ｐ６０ｍｍＨｇ，消融第一隔支后△Ｐ降至２５ｍｍＨｇ。超声术前测峰值压差△Ｐ６７．２ｍｍＨｇ，消融后，Ｄｏｐｐｌｅｒ即刻显示 Ｐ动态变化，及时测到Ｐ反弹的信息，术后即刻、４小时为３４．６ｍｍＨｇ；第２天 ７５ ｍｍＨｇ，第 ２０天△ Ｐ２３．４ｍｍＨｇ；病人症状消失。结论ＰＴＳＭＡ能有效减除梗阻程度，超声 Ｄｏｐｐｌｅｒ监测，即时观察目标血管阻断后室壁变薄的部位、范围及其对压差的影响，准确显示压差的动态变化，评价治疗效果和整体收缩功能，对定治疗决策有重要意义。Objective To report the role of echocardiography in monitoring and assessment of results of the Percutaneous transluminal septal myocardial ablation (PTSMA) which is a new therapeutic method for hypertrophic obstructive cardiomyopathy(HOCM). Methods PTSMA was performed in a 66 year old man with HOCM who was symptomatic despite adequate drug therapy. Echocardiographic evaluation was performed prior to, during and 4 hours, 1 and 20 days after the procedure. Results Left heart catheterization showed a 60 mmHg pressure gradient ( P) across the left ventricular outflow tract (LVOT), first septal branches of the coronary artery were completely blocked by injection of absolute alcohol, the P decreased to 25 mmHg. Doppler echocardiographic measured the P = 67.2 mmHg preablation, and decreased significantly as soon as the first septal branch was blocked and then doppler monitored showing the △P increased beat by beat. So the proximal segment of this branch was blocked too; △P decreased to 34.6 mmHg which Last at least 4 hours, 1 days after the △P increased to 75 mmHg because hyperdynamic systolic motion of the whole left ventricula walls excepted basical and middle segments of the interventricular septum; △P decreased to 23.4mmHg 20 days after it. The patient felt very well. Conclusion In the patient with HOCM, VISMA effectually reduced LVOT pressre gradient and septum thick-ness, each of them may change dynamics. Echocardiogra-phy is a useful method to assess these changes and is very important for deciding the treatment.

关 键 词：超声监测 心肌消融 压力阶差 心肌病 

分 类 号：R542.220.5[医药卫生—心血管疾病]