肥厚梗阻型心肌病的外科疗.pptVIP

肥厚性梗阻型心肌病的外科治疗 刘晓程 泰达国际心血管病医院 2009-10-10 常染色体显性遗传疾病 发病率1/500 谢谢！ Surgery for Hypertrophic Cardiomyopathy (HCM) Xiaocheng Liu TEDA International Cardiovascular Hospital China 2009-10-10 A autosomal dominant disease. Morbidity of HCM is 1 per 500. THANK YOU! HCM患者心电图检查可见异常Q波，T波倒置。 Most people with HCM have an abnormal ECG that can include the following: A pattern consistent with LVH, A pattern consistent with left atrial enlargement, Prominent Q waves in inferior and lateral leads, Diffuse T-wave inversions 无症状或症状轻的患者，注意事项：避免剧烈运动，以防止肥厚的心肌因缺氧进而发生心律失常。保证充足的水分摄入，避免加重症状。进行牙科手术或心脏手术前，常规应用抗生素，避免心内感染。有HCM家族史的成员应通过超声进行本病的筛查（儿童每3年1次，成人每5年1次）。 Most people with hypertrophic cardiomyopathy are able to live a normal life. People with hypertrophic cardiomyopathy, however, should not participate in strenuous activities, such as competitive athletics, but may engage in mild aerobic healthy activity, such as a walking program. During strenuous exertion, the abnormally thick heart muscle may not be able to get enough oxygen from coronary blood flow, and dangerously abnormal heart rhythms may occur. People with hypertrophic cardiomyopathy should always keep themselves well hydrated, as dehydration can cause patients to have more symptoms. Antibiotics taken before dental or surgical procedures (infective endocarditis prophylaxis) should always be used to prevent infections of the heart. Family members should undergo diagnostic screening with echocardiography. In young patients, the screening should be performed every 3 years; in adults, every 5 years. 经股动脉行介入治疗，对供养肥厚心肌的小冠状动脉选择性注入乙醇，导致相应部位心肌局部坏死。随后坏死心肌萎缩，减轻梗阻，改善症状。成功率低于外科手术，原因在于确定梗阻心肌的冠脉较为困难。可能存在因手术导致心脏传导阻滞，需安装起搏器的可能；也可能导致大面积心肌受损或发生恶性心律失常；室间隔穿孔；乳头肌梗死导致二尖瓣关闭不全。远期效果如何尚不确切。 In this procedure, the small artery of the heart that supplies the thickened muscle at the region of the obstruction is identified and alcohol is injected into this artery. The alcohol causes a localized destruction of a portion of the thick heart muscle. With time, t