心肌超声造影在肥厚型梗阻性心肌病室间隔心肌化学消融术中的价值

Value of myocardial contrast echocardiography in transcoronary ablation of septal hypertrophy for hypertrophic obstructive cardiomyopathy

目的 探讨选择性靶血管心肌超声造影在肥厚型梗阻性心肌病室间隔心肌化学消融术中选择靶血管、判断消融范围、防止并发症中的作用。方法 肥厚型梗阻性心肌病37例,室间隔心肌化学消融术中向拟定的靶血管远端注入心肌超声造影剂后即刻和注入无水酒精后5min,超声记录心尖四腔观、胸骨旁左室长轴观、左室短轴观,观察造影剂显影范围、比较造影剂显影范围和无水酒精显影范围。结果 37例患者中2例因冠状动脉血流显像技术显示无合适血管以供消融,而放弃心肌超声造影及消融治疗, 2例因冠状动脉造影显示冠状动脉分布细小弥漫而放弃治疗,未行心肌超声造影。33例行心肌超声造影的患者, 1例因左心室乳头肌显影、1例因右室调节束及右室乳头肌显影、1例因显影范围不在靶域、2例因显影范围过大放弃消融治疗。余28例均成功消融,术后即刻及术后7d,左室流出道压力阶差下降≥50%。部分病例显示无水酒精的显影范围小于心肌超声造影的显影范围。结论 心肌超声造影可为肥厚型梗阻性肌化学消融间隔支靶血管的选择及消融范围的判断提供可靠的依据。

Objective To evaluate the role of myocardial contrast echocardiography (MCE) to select target vessel, to monitor the opacification zone and to avoid complications during transcoronary ablation of septal hypertrophy(TASH) for hypertrophic obstructive cardiomyopathy(HOCM). Methods In 37 HOCM patients cardiac apex four chamber view, parasternal left ventricular long axis view and left ventricular short axis view were recorded after injection of the myocardial agents and absolute ethanol 5 minutes later respectively. And the opacification zones of the myocardial agents and absolute ethanol were observed. Results Among 37 patients,2 patients gave up treatment because of no appropriate vessel to provide ablation by coronary Doppler flow imaging.Two of 37 patients gave up treatments and did not undergo myocardial contrast echocardiography because of diffused coronary arteries in coronary angiography. Among 33 patients who underwent MCE, 5 patients gave up TASH including one of the opacification of left ventricular mammary muscles, one of the opacification of right ventricular and right ventricular mammary muscles, one for the opacification zone out of the target area and two for the large opacification zone. Other 28 patients underwent TASH successfully. Just after operations and 7 days, left ventricular outflow tract pressure gradient decreased at no less than 50%. Distribution zone of absolute ethanol was smaller than that of myocardial opacification zone in some patients. Conclusions MCE is a credible reference for selection of target vessels in TASH for HOCM.