肥厚梗阻型心肌病右室起搏后的临床血流动力学及形态学改变

目的　观察右室起搏对肥厚梗阻型心肌病患者的远期治疗效果及预后影响。方法　采用有创血液动力学监测及超声多普勒方法观察右室起搏前、后 (2小时、12周、4年 )病人的血液动力学及形态变化。结果　右室起搏 4年后临床症状、心功能、血流动力学及形态学均显著改变 ,尤其二尖瓣前向运动 (SAM)、左室流出道 (LVOT)血流速、左室流出道压力阶差 (LVOTG)、左室舒张末压 (LVEDP)、心输出量 (CO)及心脏指数 (CI)改善更为显著 (P <0 .0 0 1) ,肥厚的室间隔显著变薄 (P <0 .0 5 )。结论　右室起搏能显著地改善病人的临床症状 ,心功能及血流动力学 ,其远期疗效显著 ,并发现能逆转肥厚的室间隔及左室游离壁 ,改善LVOT梗阻。

Hemodynamics and morphology of hypertrophic obstructive cardiomyopathy after right ventricular pacing

Objective To observe the long-term clinical effect and prognosis of hypertrophic obstructive cardiomyopathy(HOCM) after right ventricular pacing (RVP). Methods Hemodynamics and morphology were observed in 60 patients with HOCM by invasive hemodynomic surveillance and ultrasonic Doppler technique before RVP and 2 hours,12 weeks,4 years after RVP. Results 4 years after RVP, clinical symptoms, cardiac function, hemodynamics and morphology in patients were improved significantly. Septum anterior moving, LVOT blood velocity, LVOT pressure gradient, LVEDP, cardiac output and cardiac index were improved especially, hypertrophic interventricular septum(IVS) became thinner. Conclusion Clinical sympotoms, cardiac function, hemodynamics were improved significantly after RVP for HOCM, long-term curative effect was better, LVS became thinner , and LVOT obstruction was decreased.