微球室间隔心肌消融术治疗肥厚型梗阻性心肌病的安全性和有效性  

Efficacy and Safety of the Microsphere Septal Myocardial Ablation for the Treatment of Patients With Hypertrophic Obstructive Cardiomyopathy

作　　者：林国钦[1] 林俊敏[1] 翁志成[2] 林丽明[1] 许开祖[1] 陈晓敏 翁育娟[3] 卓建伟[1] 吴梅芳[1] LIN Guoqin;LIN Junmin;WENG Zhicheng;LIN Liming;XU Kaizu;CHEN Xiaomin;WENG Yujuan;ZHUO Jianwei;WU Meifang(Department of Cardiology,Putian College Affiliated Hospital,Putian(351100),Fujian,China)

机构地区：[1]福建省莆田学院附属医院心血管内科,莆田市351100 [2]福建省莆田学院附属医院介入科,莆田市351100 [3]福建省莆田学院附属医院超声科,莆田市35110

出　　处：《中国循环杂志》2022年第6期590-594,共5页Chinese Circulation Journal

基　　金：福建省莆田市科技局计划项目(2019SF004)。

摘　　要：目的:评价微球室间隔心肌消融术(MSA)治疗肥厚型梗阻性心肌病(HOCM)的安全性和有效性。方法:回顾性纳入2019年6月至2021年2月在莆田学院附属医院心血管内科接受MSA(应用微粒球替代无水酒精行室间隔心肌消融术)治疗的HOCM患者10例。分析MSA术前、术后1周、1个月、3个月、6个月室间隔厚度、左心室流出道压力阶差(LVOTG)、6分钟步行距离、NYHA心功能分级、二尖瓣反流以及心肌肌钙蛋白I的变化。结果:10例HOCM患者均成功完成MSA治疗。1例室间隔厚度为26 mm、单纯栓塞第一室间隔支的MSA患者,术后随访时发现LVOTG无明显下降,且二尖瓣反流量增多,遂转心外科手术。其余9例MSA患者,与术前比较,术后1周患者的室间隔厚度与LVOTG均减小,但差异均无统计学意义(P均>0.05),术后1个月、3个月、6个月患者的室间隔厚度与LVOTG均明显减小(P均<0.05),其中LVOTG术后6个月较术前下降幅度最大,且与术后3个月相比进一步下降(P<0.05);术后6个月患者6分钟步行距离较术前、术后1周、术后1个月均有明显改善(P均<0.05);术前NYHA心功能分级Ⅳ级患者1例、Ⅲ级8例,术后6个月时Ⅱ级6例、Ⅰ级3例;术前二尖瓣重度反流3例,中度反流5例、轻度反流1例,术后6个月二尖瓣中度反流仅1例、轻度反流8例;与术前相比,患者术后1周心肌肌钙蛋白I水平明显升高(P<0.05),术后1个月基本处于正常范围。随访期间,10例MSA术后患者均未出现严重心律失常及完全性房室传导阻滞,无植入永久性心脏起搏器病例及死亡病例。结论:MSA是一种安全、有效、可行的HOCM治疗技术,尤其有益于有第一、第二室间隔支适合栓塞的HOCM患者。室间隔厚度>25 mm,且只有第一室间隔支适合栓塞的HOCM患者可能从MSA中获益较少。Objectives:To investigate of the efficacy and safety of Microsphere Septal myocardial Ablation(MSA)for patients with hypertrophic obstructive cardiomyopathy(HOCM).Methods:10 symptomatic HOCM patients who were treated with MSA(Microsphere as an alternative for alcohol in septal myocardial ablation)between June 2019 to February 2021 in the cardiovascular department of Putian College Affiliated Hospital were enrolled,and the clinical data were respectively analyzed.Interventricular septum thickness,left ventricular outflow tract gradient(LVOTG),6MWT,NYHA functional classification and troponin I were assessed pre-procedure,and one week,1 month,3 months,6 months post-procedure.Results:Ten patients underwent the procedure successfully and satisfactory effects were achieved in 9 patients.The interventricular septal thickness(IVST)was 26 mm in this failed patient,LVOTG remained unchanged and mitral regurgitation aggravated post MSA in this patient and the patient was transferred for surgical myectomy and mitral valve replacement at 3months post MSA.In the remaining 9 patients,compared with the value of pre-procedure,the interventricular septum thickness and LVOTG tended to be decreased at 1 week post-procedure(P>0.05).These values decreased significantly at 1 month,3 months,6 months post-procedure(all P<0.05).The most significant decrease of LVOTG was observed at 6 months after operation,and it further decreased compared with that of 3 months after operation(P<0.05).The reduction of IVS and LVOTG were associated with improvement of 6 MWT and NYHA functional classification(both P<0.05).Before operation,there were 1case with NYHA class IV and 8 cases of NYHA classⅢ,there were no case of NYHA classⅢ-IV at 6 months after procedure,there were 3 cases of NYHA class I and 6 cases of NYHA class II.There were 3 cases of severe,5 cases of moderate and 1 case of mild mitral regurgitation(MR)before operation,there were only 1 case of moderate and 8 cases of mild MR at 6 months after procedure.Troponin I level transitionally incr

关 键 词：微球室间隔消融术 肥厚型心肌病 安全性 有效性 

分 类 号：R54[医药卫生—心血管疾病]