经皮室间隔化学消融治疗肥厚型梗阻性心肌病疗效观察.docVIP

经皮室间隔化学消融治疗肥厚型梗阻性心肌病疗效观察中图分类号：542.2 文献标识 码：A 文章编号：1009_816X(2011)06_0425_04 DOI:10.3969/j.issn.1009_816X.2011.06.04 The Efficacy of Percutaneous Transluminal Septal Myocardial Ablation on Hypertro phic Obstructive Cardiomyopathy. CHEN Yan，FU Guo_sheng. Zhejiang Hospital，Zhejiang 310013，China ［Abstract］ Objective To evaluate the short_term efficacy of percutaneous transl uminal septal myocardial ablation(PTSMA) on hypertrophic obstructive cardiomyopa thy(HOCM). Methods 28 patients with symptomatic HOCM underwent PTSMA by Sigwart method were selected from November 2005 to Vebruary 2009,.The pressure gradient of left ventricular out floow tract (LVOTG)、thickness of septal myocardium (IVS )、width of left ventricular out floow tract (LVOT)、ejection fraction (EF) and electrocardiograms (ECG) were measured before and 1 month after PTSMA. Results P TSMA was performed 28 patients, the average alcohol injected into Septal branch was 2.46mL; the average LVOTPG before operation was (67.73±33.62)mmHg, and after operation it reduced to (29.50±25.67)mmHg (P＜0.01) and IVS was（2 4.72±6.51）mm and（22.26±5.92）mm respectively (P＜0.01). 5 patients had transitory II I°atrio_ventricular block (AVB) during operation, new_onset complete right bran ch block (CRBB) was found in 12 patients and all of them were persistent,all the clinical symptoms were relieved more or less. Conclusions PTSMA could significanty reduce LVOTG and the thickn ess of septal moyocardium. ［Key words］ Hypertrophic cardiomyopathy； Obstructive； Percut aneous transcatheter septal myocardial ablation 肥厚型梗阻性心肌病(hypertrophic obstructive cardiomyopathy，HOCM)是原发性心肌病 的一种特殊类型，约占肥厚型心肌病患者的25%［1］。临床治疗的目的是使流出道变 宽，狭窄 减轻，从而达到缓解流出道梗阻，减轻症状，降低猝死率。目前治疗的方法有药物治疗、外 科手术切断肥厚心肌和(或)二尖瓣置换术缓解梗阻症状、双腔起搏器治疗以及经皮腔内冠状 动脉室间隔化学消融(percutaneous transluminal septal myocardial ablation,PTSMA) 治疗。现将28例采用化学消融方法治疗的肥厚型梗阻性心肌病近期疗效观察报告如下 1 资料与方法 1.1 临床资料：收集2005年3月至2009年1月的28例肥厚型梗阻性心肌病患者，男15例， 女13例，年龄20～77(46.52±1 7.35)岁。术前临床表现：胸闷16例，胸痛6例，晕厥发作史6例。超声心