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超声心动图监测肥厚梗阻型心肌病经皮冠脉化学消融治疗术的临床意义 |
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何亚乐 陈纪言 林曙光 侯跃双 黄新胜 冯碧霞 许燕 李伟茹
【摘要】 目的 经皮穿隔支室间隔心肌消融(PTSMA)是治疗肥厚梗阻型心肌病的新方法，本文目的是报道超声心动图监测PTSMA的临床价值。方法 1例66岁的男性患者药物治疗效果欠佳接受PTSMA术，术前、术中、术后行超声监测。结果 消融前导管测左室与流出道的压力差ΔP 60 mmHg，消融第一隔支后ΔP降至25 mmHg。超声术前测峰值压差ΔP 67.2 mmHg，消融后，Doppler即刻显示ΔP动态变化，及时测到ΔP反弹的信息，术后即刻、4小时为34.6 mmHg；第2天75 mmHg，第20天ΔP 23.4 mmHg；病人症状消失。结论 PTSMA能有效减除梗阻程度，超声Doppler监测，即时观察目标血管阻断后室壁变薄的部位、范围及其对压差的影响，准确显示压差的动态变化，评价治疗效果和整体收缩功能，对定治疗决策有重要意义。
【关键词】 超声监测 心肌消融 压力阶差
The value of percutaneous transluminal septal myocardial ablation in hypertrophic obstructive cardiomyopathy monitored with echocardiography
He Yale Chen Jiyan Lin Shuguang
（Guangdong Cardiovascular Institute, Guangzhou 510100）
【Abstract】 Objective To report the role of echocardiography in monitoring and assessment of results of the Percutaneous transluminal septal myocardial ablation (PTSMA) which is a new therapeutic method for hypertrophic obstructive cardiomyopathy(HOCM). Methods PTSMA was performed in a 66 year old man with HOCM who was symptomatic despite adequate drug therapy. Echocardiographic evaluation was performed prior to, during and 4 hours, 1 and 20 days after the procedure. Results Left heart catheterization showed a 60 mmHg pressure gradient (ΔP) across the left ventricular outflow tract (LVOT), first septal branches of the coronary artery were completely blocked by injection of absolute alcohol, the ΔP decreased to 25 mmHg. Doppler echocardiographic measured the ΔP=67.2 mmHg preablation, and decreased significantly as soon as the first septal branch was blocked and then doppler monitored showing the ΔP increased beat by beat. So the proximal segment of this branch was blocked too; ΔP decreased to 34.6 mmHg which last at least 4 hours, 1 days after the ΔP increased to 75 mmHg because hyperdynamic systolic motion of the whole left ventricula walls excepted basical and middle segments[1] [2] 下一页
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