摘要
目的 评价我院采用PTSMA治疗 7例HOCM的近期疗效。方法 男 4 ,女 3例 ,平均年龄 (36 .6± 11)岁 ,测定静息时左心室与主动脉压差≥ 6 6 7kPa或应激压差≥ 9 33kPa,用球囊堵塞靶间隔支后压差下降和 /或杂音减轻 ,确定为靶血管。第 1间隔支消融 4例 ,第 2间隔支 2例 ,第 1和第 2支间隔支同时消融 1例 ,平均注射无水乙醇 (2 .0± 0 .8)ml。术后随访 (73± 37)d。结果 术后 7例梗阻等症状减轻或消失 ,NYHA分级增加Ⅰ～Ⅱ级 ;心脏超声示室间隔厚度由 (30 .14± 3.85 )mm降至 (2 4 .86±4 .6 7)mm(P =0 .0 0 18) ,左室流出道宽度由 (9.5± 2 .0 5 )mm增至 (14 .34± 3.19)mm(P =0 .0 0 3) ,左室与主动脉压力阶差由(9 .2 5± 1.74 )kPa降至 (4.4 3± 0 .85 )kPa(P =0 .0 0 0 8)。术中及住院期间完全性右束支阻滞 2例 ,窦性心动过缓 2例 ,房室传导阻滞及频发室性早搏 3例。 7例术后心肌酶谱均明显升高 ,最高CK(12 6 6± 6 15 )U。 1例因间歇性Ⅱ度Ⅱ型房室传导阻滞伴晕厥 ,于术后第 7天植入双腔心脏起搏器 ,1例遗留完全性右束支阻滞。结论 PTSMA是一项治疗HOCM的新技术 ,其近期疗效可靠 ,远期疗效有待于进一步观察。
Objective To evaluate efficiency and safety of PTSMA in 7 HOCM patients. Methods 7 patients (3 women, 4 men; mean age (36.6±11) years) who were symptomatic despite sufficient drug therapy, 1 to 2 septal branches in all the patients were occluded by injection of (2.0±0.8)ml of alcohol (96%) to ablate the hypertrophied interventricular septum via the central lumen after balloon occlusion of the proximal part of the septal branch. After 24～134 days, clinical outcome were determined. Results All the patients showed clinical improvement, NYHA functional class from (3.29±0.49)mm to(2.14±0.69)( P < 0.000 1 ). LVOTG reduction was achieved in all the 7 patients, the mean reduction from(9.25±1.74) to(4.43±0.85)kPa ( P = 0.000 8 ), and significant increase LVOT from (9.5±2.05)mm to(14.34±3.19)mm ( P = 0.0018). All the patients experienced angina pectoris within the first 24～72 hours, The maximal creatine kinase increase was (1 266±615)U. During operation and hospitalization, 2 patients occurrenced sinus bradycardia, 2 patients right bundle branch block, one of them developed permanent right bundle branch block, 3 patients ventricular arrhythmia and atrioventricular block, One patient required a permanent pacemaker (DDD) implantation at 7 days after operation as atrioventricular block. Conclusion Our initial PTSMA results seem promising.
出处
《重庆医学》
CAS
CSCD
2003年第1期16-17,共2页
Chongqing medicine
