经皮心肌内室间隔射频消融术治疗左心室中部肥厚型梗阻性心肌病近期效果分析

Analysis of the short-term effect of percutaneous intramyocardial septal radiofrequency ablation in the treatment of midventricular obstruction hypertrophic cardiomyopathy

目的:探讨经皮心肌内室间隔射频消融术(percutaneous intramyocardial septal radiofrequency ablation,PIMSRA)治疗左心室中部肥厚型梗阻性心肌病(midventricular obstruction hypertrophic cardiomyopathy,MVOHCM)的近期效果。方法:回顾性分析2019年12月至2022年6月期间,在武汉亚洲心脏病医院,行PIMSRA治疗的16例左心室中部肥厚型梗阻性心肌病患者的临床资料。分析患者术前、术后即刻及术后1个月及6个月超声心动图及实验室参数变化特点。超声心动图参数包括室间隔厚度、左心室中部压差、左心室质量指数、LVEDD、二尖瓣口舒张早期峰值流速(E峰)、组织多普勒测得二尖瓣环舒张早期速度(e’)等。实验室检查参数包括c Tn I及NTpro BNP。结果:16例MVOHCM患者其中男性12例,女性4例,平均年龄(43.0±14.4)岁。与术前相比,术后即刻前室间隔和后室间隔厚度均增大[(25.7±3.6)vs.(24.3±3.8)mm;(23.6±3.2)vs.(22.3±3.4)mm,P <0.05],左心室中部压差降低[(27.3±14.6) vs.(63.6±23.4)mmHg(1mmHg=0.133kPa),P<0.05]。与术后即刻相比,术后1个月和术后6个月前室间隔厚度、后室间隔厚度、左心室质量指数及左心室中部压差均减小[(20.9±3.7)vs.(16.3±1.7)vs.(25.7±3.6)mm,P <0.05;(19.5±3.4)vs.(15.1±1.5)vs.(23.6±3.2)mm,P <0.05;(166.8±25.8)vs.(142.5±21.1)vs.(189.6±29.8)g/m2,P<0.05;(20.8±15.1)vs.(15.1±9.9)vs.(27.3±14.6)mmHg,P <0.05], cTnI、NT-proBNP减小,LVEF增加,差异有统计学意义(P <0.05)。与术前相比,术后6个月患者LVEF无明显减低,4例合并室壁瘤患者室壁瘤无明显增大(P> 0.05)。术后6个月患者左心室舒张功能较术前好转,LVEDD、e`增大,E/e`比值、LAD及NT-proBNP减小,差异均有统计学意义(P均<0.05)。结论:PIMSRA可以有效解除左心室中部梗阻,手术创伤小、消融范围广、恢复快,为左心室中部肥厚型梗阻性心肌病患者提供了一种新的微创治疗方法。

Objective:To investigate the short-term effect of percutaneous intramyocardial septal radiofrequency ablation(PIMSRA)in the treatment of midventricular obstruction hypertrophic cardiomyopathy(MVOHCM).Methods:The clinical data of 16 patients with MVOHCM who were treated with PIMSRA in Wuhan Asian Heart Hospital from December 2019 to June 2022 were analyzed retrospectively.The changes of echocardiography and laboratory parameters in patients before operation,immediately after procedore,at 1 month and 6 months after operation were analyzed.Echocardiographic parameters include interventricular septal thickness,midventricular gradient,left ventricular mass index,LVEDD,early diastolic peak velocity of mitral orifice(E peak),and early diastolic velocity of mitral annulus(e`)measured by tissue Doppler.Laboratory parameters included cTnI and N-terminal precursor of B-type brain natriuretic peptide(NT-proBNP).Results:Among the 16 patients with MVOHCM,there were 12 males and 4 females,with an average age of(43.0±14.4)years.Compared with that preoperative,the thickness of anterior ventricular septum[(25.7±3.6)vs.(24.3±3.8)mm,P<0.05]and posterior ventricular septum[(23.6±3.2)vs.(22.3±3.4)mm,P<0.05]increased immediately after operation,the midventricular gradient[(27.3±14.6)vs.(63.6±23.4)mmHg,P<0.05]decreased immediately after operation.Compared with immediately after operation,the anterior septal thickness[(20.9±3.7)vs.(16.3±1.7)vs.(25.7±3.6)mm,�all P<0.05],posterior septal thickness[(19.5±3.4)vs.(15.1±1.5)vs.(23.6±3.2)mm,all P<0.05]�,left ventricular mass indexs[(166.8±25.8)vs.(142.5±21.1)vs.(189.6±29.8)�g/m2,all P<0.05],�midventricular gradient[(20.8±15.1)vs.(15.1±9.9)vs.(27.3±14.6)mmHg,�all P<0.05],cTnI and NT-proBNP were decreased at 1 month and 6 months after operation,left ventricular ejection fraction were increased at 1 month and 6 months after operation(P<0.05).Compared with preoperation,the left ventricular ejection fraction of patients 6 months after operation did not significantly decrease,and the size of ventricular aneurysm in 4 patients with ventricular aneurysm did not significantly increase(P>0.05).6 months after operation,the left ventricular diastolic function was better than that preoperative,LVEDD and e'increased,E/e'ratio,LAD and NT-proBNP decreased(all P<0.05)Conclusions:PIMSRA provides a new minimally invasive treatment for patients with midventricular obstruction hypertrophic cardiomyopathy with a wide ablation range and effective removal of the midventricular obstruction,with little surgical trauma and quick recovery.