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论著:间隔化学消融术治疗肥厚型梗阻性心肌病
Clinical Evaluation of Percutaneous Transluminal Septal Myocardial Ablation in Hypertrophic Obstructive Cardiomyopathy
林瑾仪 钱菊英 葛均波 王齐兵 樊冰 严卫 葛雷 刘学波 张峰 舒先红 潘翠珍 程蕾蕾 崔洁
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作者单位:复旦大学附属中山医院心内科
中文关键字:肥厚型心肌病;导管消融术
英文关键字:Hypertrophic cardiomyopathy; Catheter ablation
中文摘要:目的:观察经皮腔内间隔心肌化学消融术(percutaneous transluminal septal myocardial ablation, PTSMA)治疗药物难治性肥厚型梗阻性心肌病(hypertrophic obstructive cardiomyopathy, HOCM)的疗效,分析疗效与消融血管的选择、无水乙醇用量之间的关系。 方法:对21例 HOCM药物疗效欠佳的患者进行PTSMA治疗,其中男性14例,女性7例。消融术前后心导管测量左室流出道压差(left ventricular outflow-tract gradients, LVOTG)。结果:15例手术成功,消融术前后心导管测压LVOTG分别为 73.7±32.2 mmHg 和 32.0 ±26.1 mmHg(P<0.01)。单支血管消融术和多支血管消融术疗效相当,但多支血管消融使术后心肌肌钙蛋白cTnT和肌酸激酶同工酶CK-MB进一步升高(P=0.02和P=0.03)。以无水乙醇用量为横坐标,LVOTG下降为纵坐标做图,当用量在1.5~2.5 mL及4 mL左右时,LVOTG下降达高峰。线性相关回归分析显示,术后cTnT峰值(y)与无水乙醇用量(x)相关(r=0.526,P<0.05)。结论:PTSMA治疗HOCM患者的疗效满意,确定靶血管是关键,建议消融单支靶血管的无水乙醇用量以1.5~2.5 mL为宜。
英文摘要:Objective: To observe the efficacy of percutaneous transluminal septal myocardial ablation (PTSMA) in drug-refractory hypertrophic obstructive cardiomyopathy(HOCM), and to evaluate the impact of the number of target-vessel and the dose of absolute ethanol on the efficacy. Methods: PTSMA was performed in 21 patients (male 14, female 7) with symptomatic drug-refractory HOCM, left ventricular outflow-tract gradient(LVOTG) was measured before and after the procedure. Results: Procedure success was achieved in 15 patients. The average LVOTG was 73.7±32.2 mmHg before the procedure, and 32.0 ±26.1 mmHg after the procedure,P<0.01. The efficacy was comparable between the group of single target-vessel and multiple target-vessel,yet multiple target-vessel ablation elevated cTnT and CK-MB more compare to single target-vessel ablation( P=0.02 and P=0.03). Make a graph with the dose of absolute ethanol as X-axis and the reduction in LVOTG as Y-axis, the graph showed that when the dose of absolute ethanol within the range of 1.5~2.5 mL and close to 4 mL, LVOTG decrease to the most extent. Linear correlation and regression analysis showed that peak value of cTnT after PTSMA(y) was correlated with the dose of absolute ethanol(r=0.526,P<0.05). Conclusion: PTSMA is effective for symptomatic patients with HOCM. To determine the target-vessel is the key point. In single target-vessel ablation 1.5~2.5 ml is the optimal dose of absolute ethanol.
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