摘要
目的:对梗阻性肥厚型心肌病行经皮室间隔化学消融术和外科手术室间隔切除术治疗的患者进行对照研究,观察长期疗效和安全性。方法:25例行化学消融术的梗阻性肥厚型心肌病患者,以17例手术治疗的患者作为对照组。进行术前、术后1个月、术后1年和3年的随访,包括临床的心脏事件和心脏超声等。结果:1例手术患者住院期间死亡。1例化学消融患者术后1个月时发生猝死。化学消融术中2例患者出现过一过性传导阻滞。术后患者症状缓解,心功能改善。术后1个月时室间隔厚度[手术组(14.11±1.12)mm∶化学消融组(17.68±0.82)mm,P<0.05]和左室流出道压差[手术组(22.55±6.49)mm∶化学消融组(44.13±5.93)mm,P<0.05],手术组显著小于化学消融组。随着时间延长,化学消融组患者室间隔和左室流出道压差有进一步下降。随访3年时,两组差异无统计学意义。术后有左室射血分数下降,左房左室内径增大的趋势,但两组差异无统计学意义。结论:化学消融和手术切除治疗梗阻性肥厚型心肌病,均能有效缓解症状,改善患者活动能力和心功能,术后患者长期存活。化学消融术对于药物治疗不佳的患者是手术切除治疗之外的一个较好的选择。
Objective：To observe the efficacy and safety of percutaneous transluminal septal myocardial ablation （PTSMA） in hypertrophic obstructive eardiomyopathy （HOCM） patients, compared with septal myectomy （SM） in long-term. Method.. Twenty five patients underwent PTSMA, while 17 patients underwent SM. The clini- cal cardiac events and echocardiograph were followed up before the treatment, 1 month, 1 year, 3 years after the treatment. Result：One patient died in hospital after surgeon, and one patient sudden died in 1 month after PTS- MA. Two patients had temporary conduction block during PTSMA. Both treatments released symptoms and improved cardiac function. One month after the operation , compared the interventrieular septal thickness [surgi- cal group （14.11＋_1.12）ram vs ablation group （17.68＋_0.82）ram, P^0.05] and left ventricular outflow tract pressure gradient （LVOTG） [surgical group （22.55 ~ 6.49） mm vs ablation group （44.13 ! 5.93） ram, P~ 0.05], surgical group was significantly less than the ablation group. With the time pass on, the interventricular septal thickness and LVOTG in septal ablation patients decline further. Followed up for 3 years, no significant difference between the two groups. There are trends in LVEF decreasing, left atrial and left ventricular internal diameter increasing, but no significant difference between two groups. Conclusion：PTSMA and SM can effectively relieve symptoms and improve capacity and cardiac function in HOCM patients with long-term survival after treat- ment. Ablation therapy for the patients with drug refractory is a better choice besides surgeon.
出处
《临床心血管病杂志》
CAS
CSCD
北大核心
2012年第10期762-765,共4页
Journal of Clinical Cardiology
基金
国家973计划和重大科学研究计划(No:2012CB518605)
上海市科委基础研究重点专项课题(No:11JC1402400)
关键词
心肌病
肥厚型
梗阻性
经皮室间隔化学消融术
室间隔切除术
治疗
疗效
cardiomyopathy, obstructive, hypertrophic
percutaneous transluminal＇septal myocardial ablation
sep tal myectomy
treatment
effeeacy
