摘要
目的研究梗阻型肥厚性心机病患者行经皮腔内室间隔心肌消融术(PTSMA)的远期疗效。方法对67例梗阻型肥厚性心肌病患者在PTSMA后进行随访,随访时间为术后2周、6个月、1年,以后每年电话随访一次,最长至8年。记录主要心血管事件(包括死亡、心力衰竭、心肌梗死、脑卒中、严重心律失常)、临床心功能(NYHA分级)、患者自我评估的运动耐力和病情改善情况。结果 1年、4年、8年生存率分别为98.5%、95.3%、93.0%。全因死亡率为6.0%,猝死发生率为1.5%,年均猝死发生率为0.2%。4例死亡(6.0%)原因分别为心源性休克、心力衰竭、脑栓塞、猝死。1例(1.5%)术后2d急性前壁心肌梗死,1例(1.5%)术后3d出现迟发的一过性Ⅲ度房室传导阻滞,1例(1.5%)术后12个月因心房颤动导致局灶性脑梗死。无PTSMA手术相关的永久性起搏器植入病例。其余病例的临床心功能由术前NYHA(3.2±0.6)级改善至术后6个月NYHA(1.4±0.4)级(P<0.01)、术后1年NYHA(1.5±0.5)级(P<0.01)及末次随访时NYHA(1.6±0 7)级(P<0.01)患者自我评估的运动耐力改善[术前爬(2.7±3.7)层楼vs术后爬(5.1±3.4)层楼,P<0.01]自我评估病情好转比例为91%。结论 PTSMA后远期的心功能改善、生存率高、死亡率和猝死发生率低,提示PTSMA是梗阻型肥厚性心肌病的有效治疗方式之一。围术期死亡和急性心肌梗死病例少见,但提示手术风险大,仅推荐在有经验的医疗中心推广。合并心房颤动者,需预防脑卒中的发生。
Objective To study the long-term therapeutic effects of percutaneous transluminal septal myocardial ablation（PTSMA） in patients with hypertrophic obstructive cardiomyopathy（HOCM）. Methods A total of 67 consecutive symptomatic patients with HOCM underwent PTSMA. All patients had clinical follow-up at 2 weeks, 6 months, and 1 year, postoperatively. Later, annual follow-up visit was performed through phone interview, and the longest follow-up was up to 8 years. Main adverse cardiovascular events were recorded, including death, heart failure, acute myocardial infarction, cerebrovascular thrombosis, and severe arrhythmia. The NYHA class, exercise tolerance and remission of symptoms were evaluated in all patients. Results The estimated survival rates were 98.5% at 1 year, 95.3% at 4 years and 93.0% at 8 years, respectively. Four patients died, with an all-cause mortality of 6.0%. One patient（1.5%） died suddenly during exercise at 50 months postoperatively and annual sudden death rate was 0.2%. The other three patients died from cardiac shock, heart failure, and stroke, respectively. One patient（1.5%） suffered from acute anterior wall myocardial infarction at 2nd day, one（1.5%） from delayed transient Ill degree atrioventricular block at 3rd day after PTSMA, and one from non-fatal small size stroke at 12-month follow-up due to chronic atrial fibrillation. No patient required a permanent DDD-pacemaker due to post-interventional complete heart block. All patients showed clinical improvement from pre-operative NYHA class 3.2 ± 0.6 to 1.4 ± 0.4 at 6 months, 1.5 ± 0.5 at 1 year, and 1.6 ± 0.7 at final follow-up visit （P 〈 0.01）. The self-estimated exercise tolerance increased from preoperative （2.7 ± 3.7） floors to postoperative （5.1 ± 3.4） floors （P〈 0.01）. The proportion of clinical improvement by self-assessment was 91%. Conclusion PTSMA offers long-term clinical improvement and good survival without increased mortality, indicating that it is an effective treatment for symptoma
出处
《中华老年多器官疾病杂志》
2011年第2期121-124,共4页
Chinese Journal of Multiple Organ Diseases in the Elderly
关键词
经皮腔内室间隔心肌消融术
心肌病
梗阻性
存活率
手术后并发症
随访研究
percutaneous transluminal septal myocardial ablation
obstructive cardiomyopathy, hypertrophic
survival rate
postoperative complication
follow-up studies
