心肌声学造影在肥厚型梗阻性心肌病化学消融中的作用  

Effect of Myocardial Contrast Echocardiography in Patients with Hypertrophic Obstructive Cardiomyopathy in Percutaneous Transluminal Septal Myocardial Ablation

作　　者：段福建[1] 高一鸣[1] 袁建松[2] 王浩[1] 李慧[1] 王剑鹏[1] 崔锦钢[2] 邵春丽[2] 乔树宾[2] 吕秀章[1] 

机构地区：[1]中国医学科学院 北京协和医学院 国家心血管病中心 阜外心血管病医院 超声科,北京市100037 [2]中国医学科学院 北京协和医学院 国家心血管病中心 阜外心血管病医院 心内科,北京市100037

出　　处：《中国分子心脏病学杂志》2013年第5期655-658,共4页Molecular Cardiology of China

基　　金：阜外心血管病医院院所青年基金(2009-F005)

摘　　要：目的探讨心肌灌注声学造影(Myocardial Contrast Echocardiography,MCE)技术在肥厚型梗阻性心肌病(Hypertrophic Obstructive Cardiomyopathy,HOCM)经皮导管肥厚室间隔化学消融术(Percutaneous Transluminal Septal Myocardial Ablation,PTSMA)中的应用价值。方法对109例HOCM患者在PTSMA术中向拟订靶血管远端注入声学造影剂后即刻观察造影剂显影范围,选择靶血管,判断预后效果,以及制定治疗方案。结果 109例HOCM患者于PTSMA术中全部施行MCE检查,101例MCE技术判断适于PTSMA术,术后无并发症,左室流出道压力阶差(Left ventricular outcome tract pressure gradients,LVOTPG)由术前78.0±30.7mmHg降至术后即刻37.4±30.0 mmHg(p<0.001)、术后6月随访进一步下降至33.3±23.4mmHg(p<0.001),差异有明显统计学意义。8例患者压力阶差下降不明显,症状无改善,于术后或直接行外科Morrow手术。结论 MCE技术可在PTSMA术中判断远期疗效,判定正确的靶血管,避免严重的并发症、个性化制定治疗方案等方面起到关键的作用。Objective To evaluate the value of myocardial contrast echocardiography（MCE） with percutaneous transluminal septal myocardial ablation（PTSMA） for hypertrophic obstructive cardiomyopathy （HOCM）. Methods In 109 patients MCE was carried out after injection of the myocardial agents in far-end to target vessels immediately. The opacification zones of the myocardial agents were observed to select target vessels, decide the outcome and treatment prescription. Results MCE was carried out in all 109 patients. 101 underwent PTSMA, All patients have no complications. There was significant difference between the left ventricular outflow tract pressure gradient （Left ventricular outcome pressure gradients, LVOTPG） before operation and immediately after operation （78 ＋ 30.7mmHg vs. 37.4 ± 30 mmHg ,p〈0.001）. Further, the LVOTPG of postoperative follow-up in 6 moths decreased to 33.3 a= 23.4mmHg compared with the results before （p〈0.001）.The unhealthy outcome of 4 patients were forecasted by MCE, and were verified in follow-up. Pressure gradients of the 8 patients did not fall obviously. So they underwent Morrow operation insteadly. Conclusions In PTSMA, MCE play a key role to decide outcome, choose appropriate target vessels, avoid complications, and decide treatment prescriptions.

关 键 词：超声心动描记术 肥厚型梗阻性心肌病 导管消融术 心肌灌注声学造影 

分 类 号：R542.2[医药卫生—心血管疾病]