心肌声学造影指导化学消融治疗肥厚梗阻型心肌病疗效观察  

Clinical observation of myocardial contrast echocardiography-guided alcohol ablation for hypertrophic obstructive cardiomyopathy

作　　者：蒋晖[1] 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,四川成都610031

出　　处：《心脏杂志》2015年第6期676-679,共4页Chinese Heart Journal

基　　金：四川省卫生厅科研基金项目资助(120538)

摘　　要：目的探讨心肌声学造影(MCE)引导乙醇化学消融治疗肥厚梗阻型心肌病(HOCM)的临床疗效和短期预后。方法 22例肥厚梗阻型心肌病患者,术前根据超声确定梗阻相关心肌(靶域)。术中行冠脉造影,根据间隔支发出部位拟定消融血管,进一步行MCE确定消融血管(靶血管),然后注入无水乙醇行经皮室间隔化学消融术(PTSMA)治疗。术后1个月、3个月及1年监测患者超声指标、脑钠尿肽(BNP)及临床症状。结果 22例患者中,19例(86%)MCE术中心肌显影部位与术前靶域相吻合,直接行PTSMA治疗;2例(9%)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(5%)MCE显示非靶域显影而放弃消融治疗。21例(95%)患者术后即刻静息左室流出道压差(LVOTPG)下降达50%以上。随访发现室间隔厚度(IVST)、LVOTPG显著低于术前(P<0.05);术后1个月二尖瓣前叶收缩期前向运动(SAM)分级、二尖瓣反流(MR)分级也较术前明显减轻(P<0.05)。BNP由术前的(586±127)ng/L降至(202±113)ng/L(P<0.05)。患者术后1年心功能分级为1.8±0.6,较术前3.5±0.5明显改善(P<0.05)。结论在MCE引导下实施PTSMA,可精确选择靶血管并对靶域进行定位、定量消融,显著降低IVST和LVOTPG,改善患者症状,具有良好疗效。AIM To assess the effect of myocardial contrast echocardiography （MCE） -graded percutaneous transluminal septal myocardial ablation （PTSMA） for hypertrophic obstructive cardiomyopathy （HOCM）. METHODS A total of 22 consecutive HOCM patients were included. Before PTSMA treatment, target domains were determined according to conventional echocardiography. Coronary angiography was used to evaluate target blood vessels from the septal branch of the coronary artery. These vessels were then con hrain natriureticcardiac functions enhanced in these patients. CONCLUSION Percutaneous transluminal septal myocardial ablation by MCE can accurately determine target domain, select target blood vessels, quantitatively ablate focus, significantly reduce IVST/LVOTPG and ameliorate clinical symptoms in patients with HOCM.

关 键 词：心肌声学造影 超声心动图 心肌病 肥厚 梗阻型 化学消融 脑钠尿肽 

分 类 号：R542.2[医药卫生—心血管疾病]