三维超声指导下室间隔射频消融治疗肥厚梗阻性心肌病术后疗效观察

Curative effect of 3D-ultrasound-guided ventricular septal radiofrequency ablation on hypertrophic obstructive cardiomyopathy

目的探讨三维超声指导下室间隔射频消融治疗肥厚梗阻性心肌病术后疗效,并分析相关影响因素。方法回顾性分析2017年1月至2019年12月于郑州人民医院完成三维超声指导下室间隔射频消融术30例肥厚梗阻性心肌病患者临床资料,收集术前、术后即刻及出院时心脏结构情况[左心室舒张期末内径(LVEDD)、左心室流出道压差(LVOTG)、室间隔厚度(IVST)及左心室射血分数(LVEF)]、并发症及临床随访情况[NYHA心功能分级和明尼苏达心力衰竭生活质量量表(MLHFQ)]。结果30例三维超声引导下室间隔射频消融患者术前、术后即刻及出院时LVEDD、IVST、LVOTG和LVEF比较,差异有统计学意义(P<0.05),其中出院时低于术后(P<0.05),术后低于术前(P<0.05)。30例患者均无死亡,无心包积液,但术后有并发症发生,包括完全性左束支传导阻滞2例、右束支传导阻滞1例、暂时性房室传导阻滞2例。30例患者术前、出院后第1个月和第3个月NYHA心功能分级比较,差异有统计学意义(P<0.05),其中出院后第1个月(76.67%)和第3个月(100.00%)NYHAⅠ+Ⅱ级占比逐渐升高。30例患者术前、出院后第1个月和第3个月MLHFQ评分比较,差异有统计学意义(P<0.05),其中出院后第3个月低于出院后第1个月(P<0.05),出院后第1个月低于术前(P<0.05)。结论三维超声引导下室间隔射频消融术治疗肥厚梗阻性心肌病安全性良好,疗效确切,心脏结构、功能及生活质量均获得明显改善。

Objective To investigate the curative effect of 3D-ultrasound-guided ventricular septal radiofrequency ablation on hypertrophic obstructive cardiomyopathy(HOCM),and analyze relative influence factors.Methods The clinical data of HOCM patients(n=30)undergone 3D-ultrasound-guided ventricular septal radiofrequency ablation were retrospectively analyzed in Zhengzhou People’s Hospital from Jan.2017 to Dec.2019.The indexes of cardiac structure[left ventricular end-diastolic inner diameter(LVEDD),left ventricular outflow tract gradient(LVOTG),interventricular septal thickness(IVST)and left ventricular ejection fraction(LVEF)],complications and clinical follow-up[classification of NYHA heart function(NYHA)and Minnesota Living with Heart Failure Questionnaire(MLHFQ)]were collected before operation,immediately after operation and at discharge time.Results The comparison in LVEDD,IVST,LVOTG and LVEF in 30 patients showed that the difference had statistical significance before operation,immediately after operation and at discharge time(P<0.05),and LVEDD,IVST,LVOTG and LVEF were lower at discharge time than those after operation(P<0.05)and lower after operation than those before operation(P<0.05).There were no died cases and cases of hydropericardium in 30 patients,but postoperative complications were observed,including 2 cases of total left bundle branch block,1 case of right bundle branch block and 2 cases of temporary atrioventricular block.The comparison in NYHA in 30 patients before operation and after discharged for 1 month and 3 months showed that the difference had statistical significance(P<0.05),and cases of NYHA grade I accounted for 76.67%after discharged for 1 month and cases of NYHA grade II accounted for 100.00%after r discharged for 3 months.The comparison in MLHFQ scores in 30 patients showed that the difference had statistical significance before operation,immediately after operation and at discharge time(P<0.05),and MLHFQ scores were lower after discharged for 3 months than those after discharged for 1 month(P<0.05)and lower after discharged for 1 month than those before operation(P<0.05).Conclusion The curative effect of 3D-ultrasound-guided ventricular septal radiofrequency ablation is good with higher safety,and cardiac structure and function and quality of life are improved in HOCM patients.