经皮经冠状动脉室间隔化学消融术治疗梗阻性肥厚型心肌病的近期疗效观察VIP免费

基金项目:辽宁省自然科学基金资助(9910500301)通信作者:李占全,辽宁省人民医院心脏病介入治疗中心,沈阳110015·介入治疗·经皮经冠状动脉室间隔化学消融术治疗梗阻性肥厚型心肌病的近期疗效观察辽宁省化学消融术协作组【摘要】目的评价经皮经冠状动脉室间隔化学消融术(PTSMA)治疗梗阻性肥厚型心肌病(HOCM)的近期疗效。方法自1998年8月～1999年11月收治HOCM34例,入选行PTSMA26例。利用Sigwart法行PTSMA,注入96%～99%无水酒精消融间隔支前后记录左室流出道压力阶差变化、心电图变化。在消融前及术后2周通过超声心动图测量室间隔(IVS)厚度及左室流出道宽度。结果术前平均静息左室流出道压力阶差为(72.8±24.6)mmHg(1mmHg=0.133kPa),术中球囊加压后为(30.6±18.5)mmHg,术后为(24.3±17.6)mmHg,差异有显著性(P<0.001)。术前室间隔平均厚度为(23.00±6.03)mm,术后2周为(20.55±5.38)mm。术前左室流出道宽度为(6.54±2.36)mm,术后2周为(11.36±3.37)mm(P<0.01)。术前心功能(NYHA分级)为3.4±0.6,术后2周为1.6±0.8。术后CPK与CPK2Mb峰值分别为(1050±514)U/L与(131±78)U/L。术中及术后可见短阵室速、结性逸搏心律、三度房室传导阻滞及束支传导阻滞。1例发生永久性三度房室传导阻滞,安装永久性双腔起搏器。出现下壁及前壁心肌梗死心电图表现者各1例。结论PTSMA能显著降低左室流出道压力阶差,治疗HOCM的近期疗效可靠,但尚需进一步完善方法,以减少严重并发症发生,并需继续随访其中、远期疗效。【关键词】心肌病,肥大性;化学栓塞,治疗性;心脏导管插入术Short2termefficacyofpercutaneoustransluminalseptalmyocardialablationonhypertrophicobstructivecardiomyopathyLiaoningProvincialCollaborativeGroupofPTSMA(Correspondent:LIZhanquan.LiaoningProvincialPeople′sHospital,Shenyang110015,China)【Abstract】ObjectiveToevaluatetheshort2termefficacyofpercutaneoustransluminalseptalmyocardialablation(PTSMA)onhypertrophicobstructivecardiomyopathy(HOCM).MethodsThirty2fourpatientswithHOCMwerehospitalizedfromAugust,1998toNovember,1999.Amongthem26patientsunderwentPTSMAbySigwartmethod.Thechangesofleftventricularoutflow2tractgradient(LVOTG)andEKGweremeasuredbeforeandafterseptalbranchesoccludedby96%-99%alcohol.ThethicknessofseptalmyocardiumandwidthofLVOTwerealsomeasuredbeforeand2weeksafterPTSMA.ResultsLVOTGwas(72.8±24.6)mmHgand(24.3±1716)mmHgbeforeandafterablationrespectively(P<0.001).Thethicknessofseptalmyocardiumreducedfrom(23.00±6.03)mmto(20.55±5.38)mm.ThewidthofLVOTexpandedfrom(6.54±2.36)mmbeforeablationto(11136±3.37)mm2weeksafterablation(P<0.01).NYHAfunctionalclassimprovedfrom3.4±0.6beforeablationto1.6±0.8twoweeksafterablation.MaximalCPKandCPK2Mbwere(1050±514)IU/Land(131±78)IU/Lrespectively.Nonsustainedventriculartachycardia,bradyarrythmias,bundlebranchblockandtrifascicularblockswereobservedduringandafterablation.DDDpacemakerwasimplantedinonepatientbecauseofpermanentcompleteheartblock.Posteriorandanteriorwallmyocardialinfarctionswereobservedinonepatientrespectively.ConclusionPTSMAcansignificantlyreduceLVOTGandhasasatisfactoryshort2termefficacyinthetreatmentofHOCM.Furtherstudiesonmiddleandlong2ternefficacyshouldbedone.【Keywords】Cardiomyopathy,hypertrophic;Chemoembolization,therapeutic;Heartcatheterization肥厚型心肌病是一种有独特病理生理特性和多种形态、功能及临床特点的复杂心脏病。其治疗方法发展很快,对有症状患者的治疗在原有的药物及手术治疗的基础上,又出现双腔起搏器及介入治疗等新方法。经导管使用无水酒精进行经皮经冠状动脉室间隔化学消融术(percutaneoustransluminalseptal·8·中华心血管病杂志2001年1月第29卷第1期ChinJCardiol,January2001,Vol.29No.1myocardialablation,PTSMA)治疗梗阻性肥厚型心肌病(hypertrophicobstructiv...