血管定位选择在化学消融治疗肥厚梗阻型心肌病中的应用

A Clinical Study on Locating and Selecting the Septal Arteries to be Ablated in Treatment of Hypertrophy Cardiomyopathy by Chemical Catheter Ablation

目的 :评价化学消融左冠脉前降支间隔支数量、大小、位置及侧支循环对消融治疗肥厚梗阻型心肌病效果的影响。方法 :通过对 16例肥厚梗阻型心肌病 (HOCM)病人左冠前降支间隔血管的数量、大小、分布及侧支循环情况进行统计分析 ,然后用扩张球囊试阻断不同分支后观察心肌染色面积、测压差改变情况 ,最后确定合适的血管分支和消融分支的数量 ,进行化学消融 (CCA) ,统计并发症 ,手术成功标准是流出道压差低于 3 99kPa(30mmHg) ,负荷试验低于 5 32kPa(4 0mmHg)。结果 :16例病人造影显示间隔支多在 5～ 8支之间 ,可供选择操作的分支有 2～ 4支 ;第一支单支阻断 8例 ,第二单支 3例 ,第一和第二支同时消融的 5例 ,3例出现低血压 ,扩容后恢复正常 ,1例死于休克 ,术中及术后半年随访 ,都达到减阻目的。结论 :造影结果显示冠状动脉间隔支存在数量、大小、分布及有无侧支循环的差异 ,用多投射面成像 ,试阻断方法确定所选的分支及数量 ,放弃粗大及有明显侧支循环的分支可提高手术效果 ,降低并发症。

Objective:To assess the influence of the numbers,size and position of septal arteries (SA) to be ablated on the therapeutic efficacy for hypertropic obstructive cardiomyopathy (HOC).Methods:After the left coronary arteriography was done,the SAs were located and analysed,and the target arteries were selected and blocked,before CCA,test blocking by balloon should be done,and finally the coagulant-alcohol was injected-into the SA through the tube balloon which must be kept at place for 20-30 min,so that the alcohol never came back to avoid the injury of the descending branch of the lateral artery.The pressure gradient was measured,if the result was not good,other SA would be selected and blocked.Results:Out of total 5-8 SAs for each patient,2-4 SAs could be selected and blocked.First SA branch was blocked in 8 patients,second one in 3 cases and both SA bronches were blocked in 5 cases.One patient died of shock induced by a big branch blockage,all others were satisfied with the ablation.Conclusion:Since the differences in number,size and position of SA among patients exist,appropriate locating and selecting SA to be blocked by multiple angles graph and test blocking SA by balloon and avoiding blocking the big SA or SA with overt collateral circulation are very important for improving the efficacy and decreasing the complications.