11例经皮心肌内室间隔射频消融术治疗梗阻性肥厚型心肌病的近期疗效分析

Analysis of short-term effect of 11 cases of percutaneous radiofrequency ablation of intraventricular septum in the treatment of obstructive hypertrophic cardiomyopathy

目的 评估经皮心肌内室间隔射频消融术治疗梗阻性肥厚型心肌病的效果。方法 回顾性分析2019年12月至2021年06月于武汉科技大学附属武汉亚洲心脏病医院行经皮心肌内室间隔射频消融术治疗的11例梗阻性肥厚型心肌病患者,其中男性8例,女性3例,年龄26~73岁,平均(45.27±12.67)岁,所有患者术前均使用β-受体阻滞剂和/或钙离子拮抗剂治疗后症状未控制,且术前左心室流出道峰值压差(LVOT-PG)(94.73±40.88)mmHg,通过各项指标的变化评估手术疗效。结果 手术时间120~515 min,平均(228.64±112.63)min;术后住重症监护室(ICU)时间15.75~55.42 h,平均(23.42±3.65)h;术后住院时间2.73~16.96 d,平均(7.62±1.13)d。与术前相比,出院时室间隔厚度(IVS)和左心室流出道峰值压差(LOVT-PG)明显下降[(1.82±0.11)cm比(2.27±0.36)cm,P<0.05;(36.00±26.88)mmHg比(94.73±40.88)mmHg,P<0.05]。与术后即刻相比,出院时肌钙蛋白I(cTIn)和N末端B型脑钠肽原(NT-proBNP)明显降低[(1.88±1.90)ng/L比(40.20±26.38)ng/L,P<0.05;(843.04±496.05)ng/L比(1719.25±1135.92)ng/L,P<0.05]。与出院时相比,出院后1个月和6个月出院时IVS变化和LOVT-PG下降无统计学意义[(1.70±0.12)cm和(1.50±0.09)cm比(1.82±0.11)cm,P>0.05;(24.25±6.48)mmHg和(22.43±5.25)mmHg比(36.00±26.88)mmHg,P>0.05];出院后1个月和6个月cTIn、NT-proBNP及左心房内径(LA)、左心室内径(LV)、左心室射血分数(LVEF)变化均无统计学意义。术后二尖瓣反流情况改善或轻度反流,SAM消失。本组1例患者因术后并发症而死亡。结论 经皮心肌内室间隔射频消融术创伤小,可有效解除肥厚性心肌病患者流出道梗阻,缓解症状,提高生活质量和预后。

Objective To evaluate the effect of percutaneous intra-myocardial septal radiofrequency ablation(PIMSRA) in the treatment of hypertrophic obstructive cardiomyopathy(HOCM). Methods 11 cases of patients with HOCM who underwent PIMSRA in our hospital from December 2019 to June 2021 were retrospectively analyzed, including 8 males and 3 females, aged 26 to 73 years old [mean(45.27±12.67) years old].All the patients were treated with β-blockers and/or calcium antagonists before the surgery but their symptoms were not relieved. Preoperative left ventricular outflow tract peak pressure difference(LVOT-PG) was(94.73 ±40.88) mmHg. The various indicators before and after the surgery were used to evaluate the efficacy of the surgery.Results The operation time was 120-515 min, average(228.64±112.63) min;the postoperative intensive care unit(ICU) time was 15.75-55.42 h, average(23.42±3.65) h;the postoperative hospital stay 2.73-16.96 d, average(7.62±1.13) d.Compared with the preoperative, the change of ventricular septal thickness and left ventricular outflow tract peak pressure difference at discharge were significantly decreased [(1.82±0.11) cm vs.(2.27±0.36) cm, P<0.05;(36.00±26.88)mm Hg vs.(94.73±40.88) mm Hg, P<0.05]. Compared with the indicators after the surgery immediately, cardiac troponin I(c TIn)and N-terminal pro-B-type natriuretic peptide(NT-pro BNP) at discharge were significantly lower [(1.88±1.90)ng/L vs.(40.20 ± 26.38) ng/L, P<0.05;(843.04 ± 496.05) ng/L vs.(1719.25 ± 1135.92) ng/L, P<0.05]. Compared with discharged from the hospital, there were no statistically significant changes in the ventricular septal thickness and left ventricular outflow tract peak pressure difference [(1.70 ± 0.12) cm and(1.50 ± 0.09) cm vs.(1.82 ± 0.11) cm, P>0.05;(24.25±6.48) mm Hg and(22.43±5.25) mm Hg vs.(36.00±26.88) mm Hg, P>0.05] at 1 and 6 months from the discharged,and too c TIn, NT-Pro BNP, left atrial diameter, left intraventricular diameter and left ventricular ejection. Postoperative mitral regurgitation improved or with mild regurgitation, and SAM disappeared. One patient in this group died of postoperative complications. Conclusion Percutaneous intra-myocardial septal radiofrequency ablation is less traumatic and can effectively relieve the outflow tract obstruction in the patients with hypertrophic cardiomyopathy, relieve symptoms, improve the quality of life and prognosis.