血管定位与选择方法在化学消融治疗肥厚梗阻型心肌病中的意义

Significance of vascular location and selection of methods in ablation for hypertrophic obstructive cardiomyopathy.

目的评价化学消融左冠间隔支数量、大小、位置及侧支循环对消融效果的影响 [1 ]。方法对 16例肥厚梗阻型心肌病患者左冠前降支间血管的数量、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分支后观察心肌染色面积来判断心肌染色范围 ,测压差改变情况 ,确定消融分支的数量 ,进行化学消融。结果 16例造影后示第一支单阻断 8例 ,第二单支 3例 ,第一和第二同时消融的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。

Objective To evaluate the effect of the numbers, size, site and collateral circulation of septal branch of left coronary artery on ablation.Methods The numbers, size, distribution and collateral circulation of vessel among left anterior descending artery in 16 patients with hypertrophic obstructive cardiomyopathy were analyzed statistically. Then myocardium staining area was observed to judge the range of myocardium staining after branches were attempted to be occluded by use of dilated balloon. The numbers for ablation were determined according to pressure changes.Results The angiography of 16 patients showed that the first branch was occluded in 8 cases, the second in 3 cases, and the first and second in simutaneously 5 cases. Hypotension appeared in 3 cases who recovered to normal after dilated volume therapy and 1 died of shock. The aim was achieved during operation and half year follow up after operation.Conclusion There is difference in the number, size, distribution and with or without collateral circulation in septal branch of coronary artery. Selected branches and numbers can be determined by occlusion. Quit of large branches with obvious collateral circulation can improve efficiency and decrease complications.