肥厚型梗阻性心肌病经皮间隔心肌消融术后疗效及一年随访结果  

Immediate and one-year follow-up outcome of percutaneous transluminal septal myocardial ablation in patients with hypertrophic obstructive cardiomyopathy

作　　者：陈瑶[1] 朱建华[1] 郭晓纲[1] 尹小龙 郑良荣[1] 张芙荣[1] 

机构地区：[1]浙江大学医学院附属第一医院心内科,杭州310003 [2]昆明市延安医院心内科

出　　处：《中华心血管病杂志》2004年第4期326-328,共3页Chinese Journal of Cardiology

基　　金：浙江省卫生厅科学基金 ( 2 0 0 0A0 82 )

摘　　要：目的　观察经导管室间隔心肌化学消融 (PTSMA)治疗肥厚型梗阻性心肌病 (HOCM )的术后即刻和一年后随访结果。方法　分析 15例HOCM患者行PTSMA手术 ,平均随访时间为(9 9± 6 1)个月 ,随访期间患者均接受左室流出道有创压力阶差测定、心肌酶谱和心电图的检查。结果　术后即刻 ,静息时左心室流出道压力阶差 (LVOTG)由 (83 2± 17 1)mmHg (1mmHg =0 133kPa)下降至 (16 8± 8 9)mmHg ,早搏后从 (137 2± 2 4 5 )mmHg降至 (4 7 2± 16 6 )mmHg ;术后 1年LVOTG与术后即刻差异无显著性。 11例患者术中或术后出现一过性三度房室传导阻滞 (AVB) ,1例需安装永久性起搏器。 9例新发完全性右束支传导阻滞 ,均为持久性。PTSMA术后即刻体表心电图PR间期、QRS波宽、QT间期、QTc间期和QTd显著延长 ,PR间期和QTd增大在术后 1周内持续存在 ,3个月后恢复正常 ;QT间期和QTc间期在术后 1年恢复正常 ,而QRS波宽延长一直延续到术后 1年。结论　PTSMA手术能有效降低HOCM患者左室流出道压力阶差 ,但术中具有一定的危险性 ,需要引起足够的重视。PTSMA术后 1周心肌复极不一致 ,需监护注意室性心律失常的发生。1年后心电图随访结果表明PTSMA术不增加QT间期、QTd和QTc间期 ,提示PTSMA对中期心电学参数无明显影响。Objective To evaluate the immediate and one-year follow-up outcome of percutaneous transluminal septal myocardial ablation (PTSMA) in patients with hypertrophic obstructive cardiomyopathy (HOCM). Methods Fifteen patients with HOCM underwent PTSMA procedures. The changes of left ventricular outflow-tract gradient (LVOTG) and cardiac enzymes and electrocardiograms (ECG) were measured during follow-up (9.9±6.1 months). Results Immediately after PTSMA, the LVOTG reduced from 83.2±17.1 mm Hg to 16.8±8.9 mm Hg at rest(P<0.01)and from 137.2±24.5 mm Hg to 47.2±16.6 mm Hg after extrasystole(P <0.01). There was no difference between the value of LVOTG taken immediately after ablation and that measured after one-year follow-up (P>0.05). Eleven patients had transitory Ⅲ°atrio-ventricular block (AVB) during and after operation,in which 1 patient was implanted permanent pacemaker. Complete right bundle branch block (CRBB) was found in 9 patients and all of them were permanent. ECG taken immediately after PTSMA showed significant prolongation of PR interval, QRS width, correct QT interval (QTc) and QT dispersion (QTd). The change of PR interval and QTd existed continuously 1 week after ablation and recovered after 3 months. QT interval and QTc recovered one year after abalation, while the widen QRS still existed one year after abalation. Conclusion PTSMA could significantly deduce the LVOTG in patients with HOCM, but sufficient attentions should be paid to avoid some serious complications. Within one week after PTSMA, ventricular arrhythmias may appear because of dispersion of ventricular repolarization. One year ECG follow up showed that PTSMA did not increase QT interval, QTc interval and QT dispersion, suggesting that PTSMA had no significant influence on electro-parameters of the heart.

关 键 词：肥厚型梗阻性心肌病 经皮间隔心肌消融术 疗效观察 心肌酶谱 心电图 

分 类 号：R542.2[医药卫生—心血管疾病]