肥厚型梗阻性心肌病经酒精室间隔消融术后心脏结构及功能变化

Changes of cardiac structure and function in patients with hypertrophic obstructive cardiomyopathy after percutaneous transluminal alcohol septal myocardial ablation

目的探讨经皮穿刺腔内酒精室间隔心肌消融术(percutaneous transluminal alcohol septal myocardial ablation,PTSMA)对肥厚型梗阻性心肌病(hypertrophic obstructive cardiomyopathy,HOCM)患者心脏结构及功能的影响。方法收集2006年1月至2012年12月在成都市第三人民医院住院的HOCM患者24例,比较其PTSMA术前、术后3个月及术后12个月的左心室流出道压力阶差、室间隔厚度、左心室后壁厚度、左心房内径、左心室舒张末期内径、纽约心脏病协会(NYHA)心功能分级、左心室射血分数和左心室短轴缩短率的变化。结果 HOCM患者进行PTSMA术后3个月及术后12个月左心室流出道压力阶差、室间隔厚度、左心室后壁厚度、左心房内径、左心室舒张末期内径、纽约心脏病协会心功能分级、左心室射血分数和左心室短轴缩短率与术前比较,差异有统计学意义(P<0.05);术后12个月相比术后3个月,以上指标变化差异无统计学意义(P>0.05)。结论 PTSMA能显著改善HOCM患者左心室流出道梗阻及降低室壁厚度,改善患者心功能,是有效的治疗方法。

Objectives To explore the effect of percutaneous transluminal alcohol septal myocardial ablation （PTSMA）on cardiac function and structure in patients with hypertrophic obstructive cardiomyopathy （HOCM）.Methods Totally 24 HOCM patients were collected in the Third People＇s Hospital of Chengdu from January 2006 to December 2012.Left ventricular outflow tract gradient,interventricular septal thickness,left ventricular posterior wall thickness,left atrial diameter,left ventricular end-diastolic diameter,New York Heart Association （NYHA） heart functional classification,left ventricularejectionfraction （LVEF） and leftventricularfractionalshortening （LVFS） were comparedatthetime points of pre-operation,3 and 12 months post-operation.Results Left ventricular outflow tract gradient,interventricular septal thickness,left ventricular posterior wall thickness,left atrial diameter,left ventricular end-diastolic diameter,NYHA heart functional classification,LVEF and LVFS in HOCM patients were significantly different at the time points of 3 and 12 months post-operation compared with those pre-operation （P〈0.05）.There was no significance difference of these indexes between 12 months and 3 months post-operation.Conclusions PTSMA can significantly moderate left ventricular outflow tract obstruction,reduce ventricular wall thickness and improve cardiac function in HOCM patients,which is an effective treatment approach.