经皮腔内室间隔心肌消融术治疗肥厚型梗阻性心肌病的长期疗效及安全性观察  

Percutaneous transluminal septal myocardial ablation for hypertrophic obstructive cardiomyopathy:its long- term efficacy and safety

作　　者：吴弘[1] 王启平 秦永文[1] 赵仙先[1] 郑兴[1] 徐荣良[1] 马丽萍[1] 陈少萍[1] 朱嘉琦[1] 郭志福[1] 张峥[1] 李松华[1] 

机构地区：[1]上海第二军医大学长海医院心血管内科,200433 [2]浙江省湖州市长兴县人民医院心内科

出　　处：《介入放射学杂志》2014年第2期104-107,共4页Journal of Interventional Radiology

摘　　要：目的评价应用经皮腔内室间隔心肌消融术（percutaneoustransluminalseptalmyocardialablation，PTSMA）治疗肥厚型梗阻性心肌病（hypertrophicobstructivecardiomyopathy，HOCM）的长期疗效和安全性。方法2003年1月-2012年3月对41例HOCM患者行PTSMA治疗，术后随访临床症状，评价活动耐量，超声评价心脏形态学。结果术前超声测定患者室间隔厚度为（22．2±4．1）mm，压力阶差为（99．2±38．3）mmHg，左心导管检查测定压力阶差为（85．0±27．9）mmHg，无水乙醇注射量平均为（2．3±0．7）m1．分别消融l～2支前间隔支血管，第1间隔支消融32例，消融第2间隔支7例，消融第1和第2间隔支2例，术后即刻导管测左室流出道压差为（27．5±19．4）mmHg，超声测定压力阶差为（39．0±-19．8）mmHg，与术前相比差异有统计学意义（P〈0．01），消融后室间隔厚度与术前相比差异无统计学意义（P〉0．05）。术后5例患者发生完全性房室传导阻滞，4例于1周内恢复，l例1周后未恢复，行永久性人工心脏起搏器植入术。患者无围术期死亡，随访1～9年，6例失访，32例患者术后临床症状较术前持续改善。1年随访室间隔厚度为（21．6±3．4）mm，左室流出道压力阶差为（36．7±17．6）mmHg，与术后（39．0±19．8）mmHg相比．差异无统计学意义（P〉0．05）。3例患者随访期间症状复发，其中2例患者转外科行室间隔肌肉切除术，术后症状明显缓解，随访过程中无死亡病例，无缓慢性心律失常及恶性心律失常发生。结论胛SMA能有效降低HOCM患者左室流出道压力阶差，改善活动耐量，安全性好，长期疗效满意。[Abstract] Qbjective To evaluate the long-term efficacy and safety of percutaneous transluminal septal myocardial ablation （PTSMA） for hypertrophic obstructive cardiomyopathy （HOCM）. Methods During the period from January 2003 to March 2012 a total of 41 patients with symptomatic HOCM underwent PTSMA by using Sigwart＇s method in the hospital. Patients were requested to return to our center for routine clinical visit, and the activity tolerance as well as the left ventricular outflow tract gradient pressure was evaluated by echocardiography. Results The median age was 48 years old （range 18 - 79 years）. The thickness of septum measured by eehocardiography was （22.2 ＋_ 4.1 ） mm, the left ventrieular outflow tract gradient pressure measured by echocardiography was （99.2 -＋ 38.3） mmHg, and the mean gradient pressure measured by left catheterization was （85.0 ＋ 27.9） mmHg, the average volume of absolute alcohol consomed was （2.3 -＋ 0.7） ml. Of the 41 patients, the first septal branch was ablated in 32, the second septal branch was ablated in 7, and both the first and the second septal branches were ablated in 2. Immediately after the ablation, the left ventricular outflow tract gradient pressure measured by catheter was （27.5 ＋ 19.4） mmHg, and it was （39.0 ~ 19.8） mmHg measured by echocardiography. The difference in the left ventricular outflow tract gradient pressure was statistically significant between preprocedural data and postprocedural ones （P 〈 0.01）. No significant difference in the thickness of septum existed between the preprocedural data and the postprocedural ones （P 〉 0.05）. Complete A-V block was observed in 5 patients, and in 4 patients the heart rhythm returned to sinus rhythm in one week and the remaining one patient had to receive permanent pacemaker implantation. No death occurred during the perioperative period. All the patients were followed up for 1 - 9 years. The clinical symptoms were improved in 32 patients. One year after the proce

关 键 词：肥厚型心肌病 导管消融 疗效 并发症 随访 

分 类 号：R542.2[医药卫生—心血管疾病]