·308·．论著．《临床荟萃》2006年3月旦箜堂筮塑!!旦!!：!尘!!!!：超声心动图在肥厚型梗阻性心肌病经皮间隔化学消融术中的应用董静，何晓虹，张幼祥，吴成权，张建鑫，张平洋(南京医科大学附属南京第一医院心血管超声科·江苏南京210006)摘要：目的评价超声心动图在肥厚型梗阻性心肌病(HOCM)经皮经冠状动脉心肌化学消融术(PTSMA)中的应用价值方法2O例经超声心动图诊断为梗阻性肥厚型心肌痛的患者，术前确定左室流出道梗阻部位(耙区)及左宣流出道压力阶差(LVOTPG)后，进行PTSMA治疗，术中先行冠状动脉造影，球囊试验性阻断间隔支动脉(靶血管)，如果LVOTPG下降．则提示靶血管选择正确，注入无水乙醇行PTSMA治疗，术中超声心动图随乙醇注人实时监测室间隔显影部位、形态，消融心肌的面积、回声及LVOTPG的变化。结果注入无水乙醇后，17例患者心肌显影的部位与术前靶区吻合，3例心肌显影部位与术前靶区不符：室间隔右宣面显影1例，室间隔左室广泛心内膜面下显影1例，左宣侧壁基底段显影1例，访3例在超声提示下更换或增加靶血管后，也成功完成了PTSMA。本组2O例忠者术后获得良好的血流动力学效果，LVOTPG较术前下降迭5O以上或降至正常水平。结论应用超声心动图监测PTSMA，能确定消融部位及面积是否与术前靶区相符，可减少因盲目消融所导致的心肌损伤及各种并发症，并能即时监测LVOTPG变化情况，即时评价治疗效果。关麓词·肌疾病f超声·动描记术；导管消融术中圈分类号：R542．2文献标识码：A文章编号：1004—583X(2006)05—030804EffectofechocardiographyinpercutaneoustransluminalseptalmyocardialablationinpatientswithhypertrophicobstructivecardiomyopathyDONGJing．HEXiao-hong，ZHANGYou-xiang，WUCheng-quan，ZHANGJian-xin，ZHANGPing-yangDepartmentofCardiovascularUltrasoundNanjingFirstHospitalaffiliatedtoNaniingMedicalUniversity，Nanjing210006，ChinaABSTRACT：0bjectlveToevaluatethevalueofech0cardi0graphyinpercutaneoustransluminalseptalmyocardialablation(PTSMA)inpatientswithhypertrophicobstructivecardiomyopathy(HOCM)．MethodsTwentypatientswithHOCMwereenrolled．Echocardiographywasusedtoconfirmthetargetareaandleftventricularoutflowtractpressuregradient(LVOTPG)beforePTSMA．Aftercoronaryangiography(CAG)，thetargetbloodvesselsweretestedbyobstructingthemwithballoon．IfLVOTPGdecreased，itindicatedthattheseptalbrancewastherightone．Thenpurealcoholwasinjectedtothetargetvesse1．Ech0cardiographywasusedtosupervisetheenhancedregion，ablativemyocardialareaandLVOTPGduringtheoperation．ResultsTheenhancedregionwasconsistentwiththeareaconfirmedbeforeoperationin17patientsandwasnotconsistentwiththeareain3patients(1ininterventriseptumnearrightventricle。1inleftventriclesubendocardiumnearinterventriseptumand1inthebasisoflatera1)．PTSMAsucceededafterthetargetvesselswerechangedormoretargetvesselswereincluded．Twentypatientsshowedgoodhemodynamiceffect．Thesepatients"pressuregradientofleftventricledroppedover50percentortonorma1．ConclusionEchocardiographywasveryhelpfulinbothselectingtargetvesselandfindingscopeinPTSMASOastoavoidmyocardialinjuryandcomplication．TheeffectoftheoperationcanbeevaluatedtimelyfromsupervisingthechangeofLVOTPGduringoperationfromechocardiography．KEYWORDS：cadiomyopathies；echocardiography；catheterablation肥厚型梗阻性心肌病(HOCM)是一种有遗传倾向的原发性疾病，其主要特征是非对称性室间隔肥厚导致左室流出道(LVOT)狭窄，常伴有左室的高动力性收缩和左室舒张功能的减退，为缓解左室流出道梗阻，传统的治疗方法，包括使用负性频率药物(B受体阻滞剂和钙离子通道阻滞剂)，双腔全自动心脏起搏器(DDD)起搏术和外科局部心肌切除术。近年来，经皮经冠状动脉心肌化学消融术(PTSMA)，成功治疗了许多HOCM患者。PTSMA在超声心动图监测下，能...
