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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。
Objective To investigate the curative effect and short-term prognosis of myocardial hypertrophy obstructive cardiomyopathy (HOCM) guided by MCE. Methods Twenty-two patients with hypertrophic obstructive cardiomyopathy were enrolled in the study. Intraoperative coronary angiography, according to the location of the septal branch of the proposed ablation of blood vessels, further MCE ablation vessel (target vessel), and then injected ethanol percutaneous septal ablation (PTSMA) treatment. One month, three months and one year after operation, the ultrasonic indexes, brain natriuretic peptide (BNP) and clinical symptoms were monitored. Results Of the 22 patients, 19 (86%) MCE intraoperative myocardial imaging sites coincided with the preoperative target sites and were directly treated with PTSMA. In 2 (9%) MCE patients, the myocardial development was smaller than the target and the target vessels were replaced Line PTSMA treatment; 1 case (5%) MCE showed non-target-domain development and abolished ablation. In 21 patients (95%), LVOTPG decreased more than 50% immediately after the operation. LVOTPG was significantly lower than that of preoperative (P <0.05) at 1 month after IVST and at 1 month after surgery. The anterior mitral regurgitation (SAM), mitral regurgitation (MR) Also significantly reduced compared with preoperative (P <0.05). BNP decreased from (586 ± 127) ng / L preoperatively to (202 ± 113) ng / L preoperatively (P <0.05). The 1-year postoperative cardiac function score was 1.8 ± 0.6, significantly improved compared with 3.5 ± 0.5 preoperatively (P <0.05). Conclusions The implementation of MTS-guided PTSMA can accurately select target vessels and locate target sites, quantify ablation, significantly reduce IVST and LVOTPG, and improve the symptoms of patients with good curative effect.