心肌声学造影超声心动图在肥厚性梗阻型心肌病化学消融术中的作用

目的：评价心肌声学造影超声心动图（MCE）在肥厚性梗阻型心肌病经皮经冠状动脉心肌化学消融术（PTSMA）中的应用价值。方法：32例梗阻性肥厚型心肌病患者，经超声心动图确定左室流出道梗阻部位（靶域），估测左室流出道压力阶差（LVOTPG）后，进行PTSMA治疗术，术中先后MCE辅助定位，即超声实时监测心肌显影回声增强区域，如与术前靶域相吻合，则试验性球囊阻断间隔支动态（靶血管），若LVOTPG下降，提示间隔支动脉选择正确，注入无水酒精行PTSMA治疗，结果：32例患者中，24例MCE术中所见心肌显影部位与术前靶域相吻合，直接进行了PTSMA治疗术；5例MCE显示靶血管与靶域有差异，心肌显影区域过于局限2例，室间隔左室面心内膜下心肌显影1例，室间隔中段偏重于右室面心显影1例，另1例右室近调节束部位心肌显影，该5例提示纠正初选间隔支动脉，更换靶血管后，亦进行了PTSMA治疗术，3例MCE显示非靶域区显影而放弃消融治疗，本组29例患者术后均获得了良好的血液动力效果。LOVTPG较术前下降达50％以上。结论：应用MCE指导PTSMA治疗术的定位，可减少因盲目消融所导致的心肌损伤。

The effect of myocardial contrast echocardiography in percutaneous transluminal septal myocardial ablation in patients with hypertrophic obstructive cardiomyopathy

Objective To evaluate the value of myocardial contrast echocardiography (MCE) in percutaneous transluminal septal myocardial ablation (PTSMA) in patients with hypertrophic obstructive cardiomyopathy (HOCM).Methods Thirty-two patients with HOCM were enrolled,and echocardiography was used to help to orient before PTSMA.If the enhancement region was consent with the target area (the base of the sepal which leads to the obstruction of left ventricular outflow tract) confirmed pre-PTSMA,the target blood vessels were tested by obstructing them with balloon.If the pressure gradient decreased,which indicated that the septal branch was the right one,then the pure alcohol was injected to the target vessel.If not,other septal branches would be selected.Results The enhancement region was consistent with the area confirmed before operation in 24 patients,who underwent direct ablation.Opacification area was too limited in 5 patients (1 in left ventricle subendocardium near interventriseptum,1 in middle interventriseptum near right ventricle,1 in right ventricle near modulate band).The contrast was developed in non-target area in 3 patients who were given up.Twenty-nine patients showed good homodynamic effect.The patients showed good effect whose pressure gradient of left ventricle dropped over 50 per cent.Conclusions MCE is very helpful in selecting the septal branch in PTSMA.It can also help to decide the scope,which will be,infracted which will decrease the myocardial injury and complication.In all,MCE can direct the PTSMA.