【摘要】 目的 探讨经胸超声心动图术中监测对经皮腔内室间隔心肌消融术(PTSMA)治疗有症状的肥厚性梗阻型心肌病(HOCM)的临床应用价值。方法 2011年1月至2015年1月在经胸超声心动图监测下对39例HOCM患者行心肌造影(MCE),超声定位及矫正与肥厚梗阻靶区域相匹配的拟消融靶血管,测量心脏PTSMA术前及术后各参数值,并进行比较。结果 2例(5%)HOCM患者未找到匹配的间隔支血管,37例(95%)找到与梗阻区域相匹配的靶血管支并成功行PTSMA。舒张期室间隔厚度术前(2.12±0.32)mm,术后(2.05±0.31)mm;收缩期左室流出道内径术前(1.19±0.39)mm,术后(1.4l±0.38)mm;超声测量左室流出道压力阶差术前(70.01±40.30)mm Hg,术后(29.00±16.99)mm Hg;差异均有统计学意义(P<0.01)。LVOTPG超声及导管测量术前及术后均有较好相关性,术前r=0.505,术后r=0.501,P<0.01。37例患者术前均伴不同程度的SAM运动,术后SAM运动均消失。二尖瓣反流程度术前与术后比较差异有统计学意义(P<0.01)。术后未发现室间隔穿孔、心包填塞、室间隔及左室壁节段性运动异常等并发症。结论 经胸超声心动图的术中监测对经皮腔内室伺隔心肌消融术靶血管的选择具有重大作用,并可实时动态观察消融术中心脏各参数变化,使患者既能获得治疗上的最大收益又能降低医疗风险,具有重要的临床价值。更多还原

【Abstract】 Objective To evaluate the clinic value of intro-procedural guidance of transthoracic echocardiography(TTE) in percutaneous transluminal septal myocardial alilation for symptomatic hypertrophic obstructive cardiomyopathy.Methods Thirty nine HOCM patients were performed myocardial contrast guided by TTE from January 2011 to January 2015,persumed target vessel matched to obstruction area were positioned and corrected by TTE,measured the cardiac parameters before and after PTSMA,and compared the results.Results Good matched target vessel had not been found in two HOCM palients(5%),and had been found in thirty seven patients(95%),which had PTSMA therapy successfully.The thickness of septum before PTSMA measured by TTE was(2.12±0.32)mm,post was(2.05±0.31)mm,the left ventricular outflow tract dimension(LVOTd) before PTSMA was(1.19±0.39)mm,post was(1.41 ±0.38)mm.The left ventricular outflow tract pressure gradient(LVOTPG) before PTSMA measured by TTE was(70.01±40.30)mm Hg,post was(29.00±16.99)tnm Hg,the difference were all statistically significant(P<0.01).LVOTPG measured by catheter and TTE had good correlation between before and post PTSMA(before r=0.505,post r=5.01,P<0.01).Thirty seven patients all had different degree SAM actions before PTSMA,and all had vanished post PTSMA.The severity of regurgitation of mitral valve before and post PTSMA had significantly statistical difference(P<0.01).Conclusion The guidance of TTE was very important in percutaneous transluminal septal myocardial ablation for the choice of correct target vessel,and observed the variation of the cardiac parameters in dynamic real time,also can benefit the treatment results of patient and reduce the medical risk.更多还原