摘要
目的评估室间隔化学消融术(alcohol septal ablation,ASA)治疗肥厚型梗阻性心肌病(hypertrophic obstructive cardiomyopathy,HOCM)患者的临床疗效和安全性。方法 2001年1月至2015年1月行ASA的成年(≥18周岁)HOCM患者44例。术中实时监测静息和激发状态下的左室流出道压力阶差(left ventricular outflow tract gradient,LVOTG),并于术后3 d,1、3、6、12、24个月采用超声心动图检测室间隔厚度、左室射血分数、二尖瓣反流程度、左房和左室容积、估测静息状态下LVOTG值,以及心功能状态、并发症和死亡率情况。结果 44例HOCM患者ASA术后即刻,静息LVOTG由术前(79.9±37.9)mmHg下降至(33.8±30.2)mmHg(P<0.01),激发LVOTG由术前(112.4±43.8)mmHg下降至(36.8±30.0)mmHg(P<0.01)。术后常规给予β受体阻滞剂,术后6个月随访结果显示,舒张末期左房容积由术前(113.8±50.3)mL下降至(97.6±45.7)mL(P<0.01),收缩末期或舒张末期左室容积均有明显增加,左室各节段收缩同步性升高,NYHA心功能分级有明显改善,且未出现严重并发症。结论室间隔化学消融术治疗HOCM的安全性高,疗效显著,结合药物治疗可使患者长期获益。
Objective To evaluate the clinical efficacy and safety of alcohol septal ablation （ASA） in the treatment of hypertrophic obstructive cardiomyopathy （HOCM）. Methods Forty-four patients with HOCM undergoing ASA between January, 2001 and January, 2015 were enrolled in this analysis. Catheter technique was used to assess the resting and provoked left ventricular outflow tract gradient （LVOTG） in the patients. Echocardiography was performed at different time points after ASA to assess changes in the resting LVOTG, interventricular septum （IVS）, left ventricular ejection fraction （LVEF）, mitral regurgitation, left atrial volume （ LAV）, and left ventricular volume, and the changes of New York Heart Association （NYHA） functional class, and incidence of complications and mortality rate of the patients were recorded after the operation. Results Catheter measurements showed that both the resting and provoked LVOTG were decreased immediately after ASA from 79.9 ±37.9 mmHg to 33.8 ±30.2 mmHg （ P 〈 0. 01 ） and from 112.4±43.8 mmHg to 36.8± 30.0 mmHg （P 〈 0. 01 ）, respectively. blocker was prescribed for routine treatment for all patients after ASA. At 6 months after ASA, the patients showed a significant reduction of the left atrial end-diastolic volume from 113.8±50.3 mL to 97.6 ±45.7 mL （ P 〈 0. 01 ） with increased left ventricular volume and improved left ventricular synchronism and NYHA cardiac function. No episodes of complete atrioventricular block, ventricular fibrillation, or sudden cardiac death occurred in these patients after the operation. Conclusion ASA is safe and effective for treatment of HOCM in patients with suitable first septal perforator artery, and postoperative medication with β-blockers can provide the patients with long- term benefits.
出处
《第三军医大学学报》
CAS
CSCD
北大核心
2017年第16期1673-1678,共6页
Journal of Third Military Medical University
关键词
肥厚型心肌病
肥厚型梗阻性心肌病
室间隔化学消融术
实时三维超声心动图
hypertrophic cardiomyopathy
hypertrophic obstructive cardiomyopathy
chemical septalablation
real-time three dimensional echocardiography
