经皮室间隔心肌化学消融治疗12例肥厚型梗阻性心肌病的近期疗效观察.docVIP

经皮室间隔心肌化学消融治疗12例肥厚型梗阻性心肌病的近期疗效观察 【摘要】目的对我院采用经皮室间隔心肌化学消融（PTSMA）方法治疗的12例肥厚型梗阻性心肌病（HOCM）做近期疗效观察。方法12例肥厚型梗阻性心肌病患者，男8例，女4例；平均年龄（38.6±12）岁；病程1~10年；均在术前接受过β受体阻滞剂和（或）钙拮抗剂治疗效果不佳。采用RAO30°~45°体位投照下，确定靶血管后，向球囊导管中心腔内注入无水酒精，同时密切观察患者的心电图以及LVOTG的变化。所有患者术后均复查超声心动图，随访观察6个月。结果12例患者中消融第一间隔支者8例，消融第二间隔支者2例，同时消融第一、二间隔支者2例。术中出现窦性心动过缓3例，完全性右束支传导阻滞8例，频发室性早搏6例，均为一过性，无严重并发症（高度房室传导阻滞）发生。术后3例心脏杂音完全消失，9例心脏杂音减轻Ⅰ~Ⅱ级。术后超声心动图均提示原先肥厚的室间隔心肌变薄，搏动减弱，LVOTG下降，SAM现象消失，左室射血分数提高。结论PTSMA是通过PTCA技术经导管向供应肥厚室间隔心肌的间隔支动脉内注入无水酒精引起局灶性心肌梗死以达到缓解左室流出道梗阻的一种新技术。本组12例患者术后的症状、体征以及超声心动图表现均较术前有显著改善，无严重并发症出现。这表明PTSMA是一种治疗HOCM的有效方法，其近期疗效可靠，远期疗效尚待进一步观察。 【关键词】肥厚型梗阻性心肌病；经皮室间隔心肌化学消融术 【Abstract】ObjectiveToobservethecurativeeffectofPTSMAin12HOCMpatientsinthenearfuture.Methods12HOCMpatients（8men，4women，meanage38.6±12years），whosecourseofdiseasewere1~10years.Theyhadallreceiveddrugtherapysuchasβ-blockersand/orcalciumantagonistswithlesstherapeuticefficacy.AfterdeterminethetargetvesselunderRAO30°~45°，absolutealcoholwasinjectedintotheseptalbranchthroughthecentrallumenofballooncatheter.ECGandLVOTGshouldbeobservedcloselyatthesametime.Eachofthemwilltakeanechocardiogramaftertheprocedureandwillbefollowed-upforsixmonths.Results8ofthemwereperformedinthefirstseptalbranch，2wereinthesecondseptalbranch，theremaining2caseswerepeformedinbothvessels.Duringtheprocedure，sinusbradycardiawereoccurrencedin3patients，8withCRBBBand6withPVCfrequently，butallofthisweretemporarily.Thecardiacmurmurweredisappearedcompletelyin3cases，9wereattenuatedI~IIclassthanbefore.Aftertheprocedure，theechocardiogramshowedthatthehypertrophicmyocardiumofventricularseptumwasthinnerandweaken，andtheLOVTGwasdecreased，theSAMphenomenonwasdisappearedandtheLVEFwasn1 bsp;increased.ConclusionPTSMAisanewkindoftechnology，whichisusingthetechniqueofPTCA，cancausefocalmyocardialinfarctionbyinjectingtheabsolutealcoholintotheseptalbranch.Inthisgroup，thesymptom，physicalsignandtheappearanceofechocardiogramofthe12patientsweresignific