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ＰＴＳＡＭ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 Ｐ６０ｍｍＨｇ，消融第一隔支后△Ｐ降至２５ｍｍＨｇ。超声术前测峰值压差△Ｐ６７．２ｍｍＨｇ，消融后，Ｄｏｐｐｌｅｒ即刻显示 Ｐ动态变化，及时测到Ｐ反弹的信息，术后即刻、４小时为３４．６ｍｍＨｇ；第２天 ７５ ｍｍＨｇ，第 ２０天△ Ｐ２３．４ｍｍＨｇ；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。
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 ( P) across the left ventricular outflow tract (LVOT), first septal branches of the coronary artery were completely blocked by injection of absolute alcohol, the P decreased to 25 mmHg. Doppler echocardiographic measured the P = 67.2 mmHg preablation, and decreased significantly as soon as the first septal branch was blocked and then doppler monitored showing the △P increased beat by beat. So the proximal segment of this branch was blocked too; △P decreased to 34.6 mmHg which Last at least 4 hours, 1 days after the △P increased to 75 mmHg because hyperdynamic systolic motion of the whole left ventricula walls excepted basical and middle segments of the interventricular septum; △P decreased to 23.4mmHg 20 days after it. The patient felt very well. Conclusion In the patient with HOCM, VISMA effectually reduced LVOT pressre gradient and septum thick-ness, each of them may change dynamics. Echocardiogra-phy is a useful method to assess these changes and is very important for deciding the treatment.
出处
《岭南心血管病杂志》
2000年第3期185-187,共3页
South China Journal of Cardiovascular Diseases
关键词
超声监测
心肌消融
压力阶差
心肌病
Echocardiographic monitor Pressure gradient Myocardial ablation
