桡动脉途径实施经皮室间隔心肌化学消融术治疗肥厚型梗阻性心肌病  

Treating hypertrophic obstructive cardiomyopathy with percutaneous transluminal septal myocardiam ablation via a transradial approach

作　　者：曹万才 曹洪垒 周国 董兆强[3] Cao Wancai;Cao Honglei;Zhou Guo;Dong Zhaoqiang(Department of Cardiology,Shandong Third Hospital Affiliated to Shandong University,Jinan 250031,China;Department of Cardiology,the First People's Hospital of Jining,Jining 272111,China;Department of Cardiology,the Second Hospital of Shandong University,Jinan 250033,China)

机构地区：[1]山东大学附属山东省立第三医院心内科,山东济南250031 [2]济宁市第一人民医院心内科,山东济宁272011 [3]山东大学附属第二医院心内科,山东济南250033

出　　处：《临床荟萃》2020年第3期216-220,共5页Clinical Focus

摘　　要：目的探讨桡动脉途径实施经皮室间隔心肌化学消融术(PTSMA)治疗肥厚型梗阻性心肌病(HOCM)患者的疗效及安全性。方法回顾性分析通过桡动脉途径接受PTSMA治疗的32例HOCM患者的临床资料,观察患者术前及术后6个月心脏彩超的左心室流出道(LVOT)宽度、左心室流出道压差(LVOTG)以及室间隔(IVS)厚度等指标,评估PTSMA的疗效,同时观察患者并发症发生情况。结果32例患者成功完成PTSMA。术后LVOTG由术前(75.17±12.70)mmHg降至(32.42±7.62)mmHg,术后IVS厚度由术前(26.87±4.35)mm降至(17.83±3.27)mm,术后LVOT宽度由术前(6.45±2.34)mm增至(11.23±3.28)mm;术后LVOTG、LVOT宽度以及IVS厚度均优于手术前,差异均有统计学意义(P<0.01)。临床症状显著改善。11例患者术中出现一过性Ⅲ度房室传导阻滞(AVB);术后出现迟发性Ⅲ度AVB的2例患者中,置入双腔起搏器1例。无桡动脉闭塞、心包填塞、出血或急性肺栓塞等并发症,无死亡病例。结论PTSMA是治疗HOCM患者的可行方法,能够显著降低LVOTG及IVS厚度、改善临床症状,并且桡动脉途径相对安全。Objective To investigate the efficacy and safety of percutaneous transluminal septal myocardiam ablation(PTSMA)via a transradial approach in patients with hypertrophic obstructive cardiomyopathy(HOCM).Methods The clinical data of 32 patients with HOCM who underwent PTSMA treatment via a transradial approach were retrospectively analyzed.Left ventricular outflow tract(LVOT)thickness,left ventricular outflow tract gradient(LVOTG)and interventricular septal(IVS)thickness and other indicators were observed and compared by cardiac color Doppler ultrasonography before and six months after the surgery.The efficacy of PTSMA was evaluated,and the occurrence of complications were observed simultaneously.Results PTSMA were successfully performed for 32 patients.The postoperative LVOTG decreased from(75.17±12.70)mmHg to(32.42±7.62)mmHg,and the postoperative IVS thickness decreased from(26.87±4.35)mm to(17.83±3.27)mm.The preoperative LVOT thickness increased from(6.45±2.34)mm to(11.23±3.28)mm.Postoperative LVOTG,LVOT width and IVS thickness were better than before surgery,all with statistically significant differences(P<0.01).The clinical symptoms were remarkably improved.In 11 patients,transient third-degree atrioventricular block(AVB)occurred during operation.In two patients with postoperative delayed third-degree AVB,one patient received a dual-chamber pacemaker.There were no complications such as radial artery occlusion,pericardial tamponade,hemorrhage or acute pulmonary embolism.No dead case was found.Conclusion PTSMA is a feasible method for treating HOCM,which can significantly decrease LVOTG and IVS thickness,improve clinical symptoms,and the transradial approach is relatively safe.

关 键 词：心肌病 肥厚性 经皮室间隔心肌化学消融术 桡动脉 

分 类 号：R542.2[医药卫生—心血管疾病]