化学消融术治疗肥厚型梗阻性心肌病疗效观察

目的评价经皮经腔间隔心肌化学消融术(PTSMA)治疗肥厚型梗阻性心肌病(HOCM)的中期疗效,以及影响预后的因素。方法33名肥厚型梗阻性心肌病患者入选行PTSMA,术前完善相关检查,术中测量压力阶差,术后定期复查心电图及超声心动图进行跟踪随访。结果每例患者使用无水乙醇量(1.0～9.0)ml,平均(3.6±1.9)ml,消融间隔支数1～3支,平均(1.3±0.6)支。消融术前左室流出道压力阶差(LVOTG)平均为(98.8±35.4)mmHg,消融术后左室流出道压力阶差平均为(16.1±23.5)mmHg,与术前相比差异有统计学意义(P<0.01);消融术前室间隔(IVS)厚度为(25.2±5.7)mm,消融术后2年室间隔厚度为(18.1±3.3)mm,与术前相比差异有统计学意义(P<0.01),消融间隔支数不同者,术后室间隔变薄程度不同(P<0.01);消融术前左心房内径为(45.6±6.6)mm,消融术后2年左房内径为(39.9±4.9)mm,与术前相比差异有统计学意义(P<0.01);消融术前左室内径为(40.9±6.9)mm,消融术后2年左室内径为(46.4±5.2)mm,与术前相比差异有统计学意义(P<0.01)。结论经皮经腔间隔心肌化学消融术能显著降低左室流出道压力阶差,降低室间隔厚度,改善左室舒张功能,降低左房压力,并随着时间延长疗效逐渐增加。

Percutaneous transluminal septal myocardial ablation for hypertrophic obstructive cardiomyopathy:long term follow up of 33 patients

Objective To evaluate the efficacy of percutaneous transluminal septal myocardial ablation（PTSMA） on hypertrophic obstructive cardiomyopathy（HOCM）.Methods From February 2004 to July 2006,PTSMA was performed in 33 patients（mean age 42.7 years ±11.5 years,male 22,female 11）with symptomatic HOCM and inadequate response to pharmacologic therapy.LVOTG was measured before and after the ablation and all the patients had electrocardiogram and echocardiography performed prior to the procedure and were follow up to（22.7±10.4）month.Results After 2-year follow-up the LVOTG decreased from 98.8 mmHg ±35.4 mmHg before ablation to 16.1 mmHg ± 23.5 mmHg after that（P0.01）,and the thickness of the interventricular septum（IVS）reduced from 25.2 mm ±5.7 mm before ablation to 18.9 mm±3.9 mm at 1 year after PTSMA,and 18.1 mm ± 3.3 mm at 2 years （P 0.01）.Variant numbers of the ablative branch makes the difference of the septal prognosis（P0.01）.Left-atrial inside diameter lessened from 45.6 mm ± 6.6 mm to 39.9 mm ± 4.9 mm（P0.01）;left-ventral inside diameter decreased from 40.9 mm ± 6.9 mm to 46.4 mm ± 5.2 mm（P0.01）.Conclusions PTMSA is a promising non-surgical procedure for treating symptomatic patients with HOCM with low risk and good clinical effect.