心肌声学造影在肥厚型梗阻性心肌病无水乙醇化学消融术中的应用  

Application of myocardial contrast echocardiography in alcohol ablation in hypertrophic obstructive cardiomyopathy patients

作　　者：熊峰[1] 唐炯[1] 王淑珍[1] 冯坤[1] 张梅[1] 

机构地区：[1]成都市第三人民医院心内科,610031

出　　处：《临床超声医学杂志》2014年第11期724-728,共5页Journal of Clinical Ultrasound in Medicine

基　　金：四川省卫生厅科研基金项目(120538)

摘　　要：目的评价心肌声学造影(MCE)在经皮经冠状动脉心肌化学消融术(PTSMA)治疗肥厚型梗阻性心肌病的应用价值。方法 22例肥厚型梗阻性心肌病患者,术前超声观察二尖瓣前叶收缩期前向运动(SAM征)与室间隔接触点,脉冲多普勒测量左室流出道流速加速点,相应水平肥厚的室间隔确定为梗阻相关心肌(靶域)。术中行冠状动脉超声造影,根据室间隔支发出部位拟定消融血管;行MCE,若心肌显影范围与梗阻心肌范围吻合则确定该室间隔支为支配靶域的消融血管(靶血管),注入无水乙醇行PTSMA治疗。结果 22例患者术中,19例MCE心肌显影部位与术前靶域相吻合,直接行PTSMA治疗;2例MCE显示心肌显影区域小于靶域,更换靶血管后行PTSMA治疗;1例MCE显示非靶域显影而放弃消融治疗。21例患者术后即刻静息左室流出道压差(LVOTPG)下降达50%以上。PTSMA术后1、3、12个月IVST、LVOTG较术前减小(P<0.05)。术后1个月SAM评分、二尖瓣反流评分较术前减小(P<0.05),术后3个月、1年与术后1个月差异无统计学意义。结论 MCE在PTSMA术中能引导定位定量消融心肌,减少盲目消融导致的非靶域心肌损伤。Objective To evaluate the application value of myocardial contrast echocardiography （MCE） in alcohol ablation in hypertrophic obstructive cardiomyopathy patients （PTSMA） . Methods Twenty patients with hypertrophic obstructive cardiomyopathy were examined by preoperative conventional ultrasound. Systolic anterior motion （SAM） of the anterior mitral leaflet and ventricular septal contact point and pulse doppler measurement of left ventricular outflow velocity acceleration were observed. The hypertrophic ventricular septal at corresponding level were defined as obstruction myocardial （target domain）. Coronary ultrasound angiography was performed and blood vessels for ablation were determined according to the site where septal perforating arteries started. MCE was then performed, if myocardial imaging scope agreed with obstruction range, the target domain of ablation vascular （target blood vessels） would be determined, and anhydrous alcohol would be injected for PTSMA treatment. Results Myocardial imaging parts were in conformity with the preoperative target domain 19 of 22 cases received MCE and PTSMA treatment was directly performed. MCE showed myocardial imaging area was less than the target domain in 2 cases, PTSMA treatment was performed after the target vessel was changed. The ablation was abandoned in 1 case as non-target domain was shown by MCE. Immediate LVOTPG decrease by more than 50%was showed in 21 patients. Interventricular septum thickness and LVOTPG, were reduced at 1, 3 and 12 months after PTSMA treatment. The score of SAM and mitral valve regurgitation were reduced compare to those before treatment. But no statistical differences were found among those at 1, 3 and 12 months after PTSMA treatment. Conclusion MCE in PTSMA operation can quantitatively guide positioning for ablation myocardial and reduce myocardial injury of non-target domain due to blindly ablation.

关 键 词：超声心动描记术 造影剂 肥厚型梗阻性心肌病 化学消融 

分 类 号：R542.2[医药卫生—心血管疾病] R540.41[医药卫生—内科学]