梗阻性肥厚型心肌病经皮化学消蚀术后长期随访研究  

Long-term follow-up study of percutaneous transluminal septal myocardial ablation for hypertrophic obstructive cardiomyopath

作　　者：陈绍良[1] 段宝祥[1] 何晓红[1] 张幼祥[1] 叶飞[1] 刘志忠[1] 纪勤炯[2] 毛鑫祥[3] 

机构地区：[1]南京医科大学附属南京市第一医院心内科,210006 [2]皖南医学院附属弋矶山医院 [3]江苏省靖江市人民医院

出　　处：《中国介入心脏病学杂志》2003年第1期21-24,共4页Chinese Journal of Interventional Cardiology

摘　　要：目的　研究经皮化学消蚀术治疗梗阻性肥厚型心肌病的长期随访结果。方法　 13例不合并高血压的梗阻性肥厚型心肌病患者 ,左心室流出道压力阶差均 >40mmHg ,且长期药物治疗无效。其中 2例肥厚部位同时包括左心室侧壁和右心室。术后每月门诊记录临床症状变化及心电图 1次 ;术后 2 4h及每月行经胸超声检查 1次 ,测定室间隔厚度 (IVST)、心室腔直径 (LVDD)、左心室流出道压力阶差 (LVOTG)及左心室射血分数 (LVEF)。平均随访时间 2 0 (14～ 2 2 )个月。结果　 13例患者术前收缩期二尖瓣前向移动 (SAM)现象平均 3 6级 ;平均酒精注射量为 3 86ml;术后即刻左心室流出道压力阶差平均下降到 31mmHg ,术后 1个月室间隔厚度降低程度最大平均 (3 0± 0 4)mm ;术后 1个月时SAM分级平均下降到 1 4级 (平均下降 2 2级 ) ;无一例需要再次另外一支间隔支消蚀的 ;2例患者出现进行性左心室扩大 ,但是均于术后 3个月后停止 ;全部患者的临床症状均得到显著改善 ,1例患者于术后 3个月时出现活动后胸闷 ,心脏超声与导管复查左心室流出道压力阶差回升到 >36mmHg ;3例患者术中出现一过性完全性房室传导阻滞 ,2例术后 1h内恢复到正常窦性心律 ;1例完全性房室传导阻滞于术后第 3天消失 ,因此无 1例需要安装永久起搏器。 4例 (2 2 %Objective To study the long-term follow-up results of percutaneous transluminal septal myocardial ablation (PTSMA) for hypertrophic obstructive cardiomyopath (HOCM). Methods 13 cases resistant to long-term medical therapy and without systemic hypertension in all cases were enrolled into the present study (left ventricular outflow tract pressure gradient >40 mm?Hg). Clinical symptoms and ECG were recorded monthly, cardiac echo was videoed 24 hours and each month after the procedure for an average 20 months follow-up period. Results Left ventricular lateral and right ventricular anterior wall were involved in 2 cases with septal hypertrophy. SAM (systolic anterior movement) was reduced from 3.6 to 1.4 with an average alcohol injection usage of 3.86 ml; the largest reduction of LVOTG and intraventricular septal thickness (IVST) was seen 1 month after the procedure (from 77 mm?Hg to 31 mm?Hg and from 24 mm to 21 mm, respectively). No other septal branch ablation was needed. 2 progressive left ventricular enlargement took place within 1 month after the procedure, which stopped within 3 month. Symptoms were improved after the procedure, but 1 case had dyspnea reoccurred 3 month after the procedure with a LVOTG>36 mm?Hg. No permanent cardiac pacemaker was implanted. Transit trifascicular was seen in 3 cases, of whom, 2 disappeared with 1 hour after the procedure and, 1 trifascicular disappeared with 3 days. Permanent branch blocks were demonstrated in 36% patients. Conclusion PTSMA was feasible for HOCM with controllable complications. Precise position was the key point to prevent the alcohol leakage which will induce large area myocardial infarction and cardiac shock. Further study was needed to appreciate the more long-term follow-up.

关 键 词：梗阻性肥厚型心肌病 经皮化学消蚀术 随访研究 治疗 

分 类 号：R542.2[医药卫生—心血管疾病]