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|本期目录/Table of Contents|

心肌声学造影指导化学消融治疗肥厚梗阻型心肌病疗效观察

《心脏杂志》[ISSN:1009-7236/CN:61-1268/R]

期数:
2015年第6期
页码:
676-679
栏目:
临床研究
出版日期:
2015-07-15

文章信息/Info

Title:
Clinical observation of myocardial contrast echocardiography-guided alcohol ablation for hypertrophic obstructive cardiomyopathy
作者:
蒋 晖; 熊 峰; 唐 炯; 王淑珍; 冯 坤; 张 梅
（成都市第三人民医院心内科，四川 成都 610031）
Author(s):
JIANG Hui;  XIONG Feng;  TANG Jiong;  WANG Shu-zhen;  FENG Kun;  ZHANG Mei
(Department of Cardiology, Third People’s Hospital, Chengdu 610031, Sichuan, China)
关键词:
心肌声学造影; 超声心动图; 心肌病; 肥厚; 梗阻型; 化学消融; 脑钠尿肽
Keywords:
myocardial contrast echocardiograpy;  echocardiography;  cardiomyopathy;  obstructive;  hypertrophic;  percutaneous transluminal septal myocardial ablation;  brain natriuretic peptide
分类号:
R542.2
DOI:
-
文献标识码:
A
摘要:
目的 探讨心肌声学造影（MCE）引导乙醇化学消融治疗肥厚梗阻型心肌病（HOCM）的临床疗效和短期预后。方法 22例肥厚梗阻型心肌病患者，术前根据超声确定梗阻相关心肌（靶域）。术中行冠脉造影，根据间隔支发出部位拟定消融血管，进一步行MCE确定消融血管（靶血管），然后注入无水乙醇行经皮室间隔化学消融术（PTSMA）治疗。术后1个月、3个月及1年监测患者超声指标、脑钠尿肽( BNP)及临床症状。结果 22例患者中，19例(86%)MCE术中心肌显影部位与术前靶域相吻合，直接行PTSMA治疗；2例(9%)MCE显示心肌显影区域小于靶域，更换靶血管后行PTSMA治疗；1例(5%)MCE显示非靶域显影而放弃消融治疗。21例(95%)患者术后即刻静息左室流出道压差(LVOTPG)下降达50%以上。随访发现室间隔厚度(IVST)、LVOTPG显著低于术前（P<0.05）；术后1个月二尖瓣前叶收缩期前向运动(SAM)分级、二尖瓣反流(MR)分级也较术前明显减轻（P<0.05）。BNP由术前的(586±127) ng/L降至(202±113) ng/L（P<0.05）。患者术后1年心功能分级为1.8±0.6，较术前3.5±0.5明显改善（P<0.05 ）。结论 在MCE引导下实施PTSMA，可精确选择靶血管并对靶域进行定位、定量消融，显著降低IVST和LVOTPG，改善患者症状，具有良好疗效。
Abstract:
AIM To assess the effect of myocardial contrast echocardiography (MCE)-guided percutaneous transluminal septal myocardial ablation (PTSMA) for hypertrophic obstructive cardiomyopathy (HOCM). METHODS A total of 22 consecutive HOCM patients were included. Before PTSMA treatment, target domains were determined according to conventional echocardiography. Coronary angiography was used to evaluate target blood vessels from the septal branch of the coronary artery. These vessels were then confirmed by MCE. After 1 month, 3 months, and 1 year, echocardiographic parameters, brain natriuretic peptide, and clinical symptoms were reassessed. RESULTS Myocardial imaging parts by MCE were in conformity with the target domains in 19/22 cases who were assigned for PTMSA. Two cases had myocardial imaging parts smaller than the primary target domains; thus, the target vessels were changed before PTMSA. One patient was rejected for PTMSA due to myocardial imaging of non-target domain. Immediate resting left ventricular outflow tract pressure (LVOTPG) decreased by >50% in 21 patients after PTMSA. Significant improvement was observed in interventricular septum thickness (IVST), mitral valve regurgitation, former systolic mitral valve motion, and brain natriuretic peptide. One-year follow-up showed that cardiac functions enhanced in these patients. CONCLUSION Percutaneous transluminal septal myocardial ablation by MCE can accurately determine target domain, select target blood vessels, quantitatively ablate focus, significantly reduce IVST/LVOTPG and ameliorate clinical symptoms in patients with HOCM.

参考文献/References

[1]van der Lee C,ten Cate FJ,Geleijnse ML,et al.Percutaneous versus surgical treatment for patients with hypertrophic obstructive cardiomyopathy and enlarged anterior mitral valve leaflets[J].Circulation,2005,112(4):482-488.
[2]Bonow RO,Carabello BK.ACC/AHA2006 guidelines for the management of patients with valvular heart disease: A report of the American Coliege of Cardiology/American Heart Association Task Force Oil Practice Guidelines(writing Committee to Revise the 1998 guidelines for the management of patients with valvular heart disease)[J].J Am Coll Cardiol,2006,48(3):el-e148.
[3]Sigwart U.Non-surgical myocardial reduction for hypertrophic obstructive cardiomyopathy[J].Lancet,1995,346 (8969):211-214.
[4]何怡华,李治安,姜腾勇,等.冠状动脉血流多普勒显像在肥厚型梗阻性心肌病化学消融术中的应用价值[J].中华超声影像学杂志,2004,13(5):336-340.
[5]李占全,石蕴琦.室间隔化学消融治疗肥厚型梗阻性心肌病15年回顾[J].国际心血管病杂志,2011,38(1):1-4.
[6]Kitaoka H,Kubo T,Okawa M,et al.Plasma adiponectin levels and left ventricular remodeling in hypertrophic cardiomyopathy[J].Int Heart J,2010,51(1):51-55.
[7]Maron BJ,Tholakanahalli VN,Zenovich AG,et al.Usefulness of B-type natriuretic peptide assay in the assessment of symptomatic state in hypertrophic cardiomyopathy[J].Circulation,2004,109(8):984-989.
[8]Mutlu B,Bayrak F,Kahveci G,et al.Usefulness of N-terminal pro-B-type natriuretic peptide to predict clinical course in patients with hypertrophic cardiomyopathy[J].Am J Cardiol,2006,98(11):1504-1506.
[9]Nishigaki K,Tomita M,Kagawa K,et al.Marked expression of plasma brain natriuretic peptide is a special feature of hypertrophic obstructive cardiomyopathy[J].J Am Coll Cardiol,1996,28(5):1234-1242.
[10]Briguori C,Betocchi S,Manganelli F,et al.Determinants and clinical significance of natriuretic peptides and hypertrophic cardiomyopathy[J].Eur Heart J,2001,22(15):1328-1336.

备注/Memo

备注/Memo:
收稿日期：2014-10-10.
基金项目：四川省卫生厅科研基金项目资助（120538）
通讯作者：熊峰，副主任医师，主要从事结构性心脏病、高血压和心衰研究 Email：496884618@qq.com
作者简介：蒋晖，副主任医师,硕士 Email：janghui3331@sina.com
更新日期/Last Update: 2015-07-23