肥厚型梗阻性心肌病经皮室间隔消融后的左室逆重构  

Reverse remodeling of left ventricular after percutaneous transluminal septal myocardial ablation in patients with hypertrophic obstructive cardiomyopathy

作　　者：唐媛[1] 张彦[1] 高峰[1] 罗瑞英[1] 林施峰[1] 朱绍亨[1] 

机构地区：[1]福建医科大学附属宁德市医院心内科,福建省宁德市352100

出　　处：《中国心血管病研究》2014年第1期14-17,共4页Chinese Journal of Cardiovascular Research

基　　金：福建省宁德市科技局科技计划项目资助（项目编号：20120098）

摘　　要：目的 观察经皮室间隔心肌化学消融（PTSMA）治疗肥厚型梗阻性心肌病（HOCM）的术后即刻和动态随访左心室结构和功能的变化.方法 应用心脏超声评估14 例HOCM 患者行 PTSMA 手术术前,术后即刻,术后 1个月、3个月、6个月、12个月左心室大小、各左室壁厚度和心脏功能.结果 消融前患者室间隔厚度平均为（21.53±4.00）mm,左室后壁平均为（11.0±2.2）mm,左室流出道平均压力为（83.0±27.7）mm Hg.消融后即刻患者心室结构无明显变化,但流出道压力减至（28.2±24.7）mm Hg.1个月后复查心脏彩超,室间隔厚度减少至（14.3±3.7）mm,左室后壁平均为（11.6±6.3）mm,左心室舒张末期内径从术前的（42.1±4.9）mm增加至术后的（47.3±6.8）mm,左心室收缩末期内径从术前的（26.4±3.4）mm增加至术后的（32.4±8.8）mm,后随访至1年无继续增大.左心室射血分数在随访3个月时较术前下降,但仍在正常心功能范围.结论 PTSMA手术能有效降低 HOCM患者左室流出道压力阶差,并能引起左心室发生良性逆重构.Objective The aim of this study was to evaluate the dynamic change of left ventricular structure and function of percutaneous transluminal septal myocardial ablation （PTSMA） in patients with hypertrophic obstructive cardiomyopathy. Methods A total of 14 consecutive symptomatic patient underwent PTSMA. All patients with I-IOCM underwent cardiac ultrasound, PTSMA surgical, preoperative and postoperative 1 month, 3 months, 6 months, 12 months after operation, and the left ventricular size, the left ventricular wall thickness and heart function were evaluated. Results Before ablation ventricular septal thickness with an average of （21.5±4.0） mm, left ventricular posterior wall with an average of （11.0±2.2）mm. Left ventricular outflow tract average pressure of （83.0±27.7）mm Hg. After ablation ventricular structure has no obvious change, but outflow pressure decreased to （28.2±24.7）mm Hg. After 1 month, echocardiogram showed ventricular septal thickness reduce to （14.3±3.7） mm, left ventricLLlar posterior wall was （11.6±6.3）mm. Left ventricular end-diastolic diameter increased from （42.1±4.9）mm in postoperative preoperatively to （47.3±6.8）mm, left ventricular end systolic diameter increased from （26.4±3.4）mm in postoperative preoperatively to （32.4±8.8）mm, after 1 year follow-up the diameters have no continue increase. Left ventricular ejection fraction during follow-up of 3 months was down, but was still in the scope of normal cardiac function. Conclusion PTSMA operation can effectively reduce the left ventricular outflow tract in patients with HOCM pressure difference, and can cause benign reverse left ventricular reconstruction.

关 键 词：肥厚梗阻型心肌病 化学消融 心脏超声 左心室 重构 

分 类 号：R542.2[医药卫生—心血管疾病]