摘要
目的 应用冠状动脉 (冠脉 )血流显像技术显示前降支及间隔支血流和血流流速曲线 ,为肥厚型梗阻性心肌病化学消融的靶血管选定及术后侧支循环形成状况的判定提供依据。方法 肥厚型梗阻性心肌病 2 8例 ,于化学消融术前和消融术后 ,采用胸骨旁左心室长轴、胸骨旁左心室短轴、胸骨旁心底短轴观显示前降支、室间隔支的血流 ,频谱多普勒测量血流速度、流速积分。结果 与冠脉造影对照 ,并经化学消融术结果证实 ,应用冠脉血流显像技术有效地选择靶血管首次成功 2 2例 ,2例加选其他间隔支再次消融成功 ,共 2 4例成功实施心肌化学消融术。 2例间隔支血管分布细小弥漫放弃消融 ,1例因术中心肌超声造影分布于右心室面及右心室乳头肌放弃消融 ,1例造影剂分布于左心室乳头肌放弃消融。 2 4例靶血管舒张期冠脉血流量参数与术中靶血管无水酒精注射量呈明显正相关。术后 5例左心室流出道压力阶差出现反弹 ,3例可见邻近的间隔支向消融区域延伸、血流速度增快 ,1例发现消融血管残端明显延长。结论冠脉血流显像可以直接显示肥厚型梗阻性心肌病的室间隔支 ,能为心肌化学消融治疗提供更详细的血流动力学信息 ,可以有效而可靠地监测肥厚型梗阻性心肌病化学消融术。
Objective To show left anterior descending artery and interventricular septal branch Doppler flow and Doppler flow spectrum using coronary Doppler flow imaging,provide reference to select target artery,and judge collateral circulation formation after percutaneous transluminal septal myocardial ablation (PTSMA) of hypertrophic cardiomyopathy. Methods In 28 patients with hypertrophic cardiomyopathy left anterior descending artery and interventricular septum branch flow were displayed using coronary flow Doppler imaging system before and after PTSMA,and flow velocity were measured by Doppler spectrum. Results In 22 patients the target arteries were successfully selected in the first time using coronary flow Doppler imaging combined with coronary angiography and proved by the results of PTSMA. In 2 patients PTSMAs were performed successfully after additional choosing other interventricular septal branch. Therefore,PTSMAs in 24 patients were performed effectively in total. In 4 patients PTSMAs were given up due to vessel thinness and suffusion of interventricular septal branch in 2 patients,myocardial contrast agent distributing right ventricular and right ventricular papillary muscle during operation in one patient and contrast agent distributing left ventricular papillary muscle in another patient. Left ventricular flow tract pressure rebounded in 5 patients postoperatively,and neighboring interventricular septum branch extending to melting area were seen in 3 patients accompanied by flow velocity increasing. Melted vessel nub markedly prolonged in 1 patient. Conclusions Coronary Doppler flow imaging can directly reveal interventricular septum branch flow in hypertrophic cardiomyopathy,provide detailed hemodynamic information for myocardial PTSMA and monitor PTSMA for hypertrophic cardiomyopathy effectively and reliably.
出处
《中华超声影像学杂志》
CSCD
2004年第5期336-340,共5页
Chinese Journal of Ultrasonography
基金
北京市自然科学基金资助项目 (70 4 2 0 2 3)