·临床研究·

    作者单位:100029 北京,首都医科大学附属北京安贞医院超声诊

    断科(栾姝蓉、李治安、何怡华、裴金凤、孙琳、房芳) ;江西医科大学附属

    第一医院超声科(陈小珠)

    心肌声学造影超声心动图在肥厚性梗阻型

    心肌病化学消融术中的作用

    栾姝蓉 李治安 何怡华 裴金凤 孙琳 房芳 陈小珠

    【摘要】 目的 评价心肌声学造影超声心动图(MCE)在肥厚性梗阻型心肌病经皮经冠状动脉心肌化学消

    融术(PTSMA)中的应用价值。方法 32 例梗阻性肥厚型心肌病患者 ,经超声心动图确定左室流出道梗阻部位

    (靶域) ,估测左室流出道压力阶差(LVOTPG)后 ,进行 PTSMA治疗术 ,术中先行 MCE辅助定位 ,即超声实时监

    测心肌显影回声增强区域。如与术前靶域相吻合 ,则试验性球囊阻断间隔支动脉(靶血管) ,若 LVOTPG下降 ,提示间隔支动脉选择正确 ,注入无水酒精行 PTSMA治疗。结果 32 例患者中 ,24 例 MCE术中所见心肌显影部

    位与术前靶域相吻合 ,直接进行了 PTSMA治疗术;5 例 MCE显示靶血管与靶域有差异 ,心肌显影区域过于局限

    2例 ,室间隔左室面心内膜下心肌显影 1 例 ,室间隔中段偏重于右室面心肌显影 1 例 ,另 1 例右室近调节束部位

    心肌显影 ,该 5 例提示纠正初选间隔支动脉 ,更换靶血管后 ,亦进行了 PTSMA 治疗术;3 例 MCE显示非靶域区

    显影而放弃消融治疗。本组 29 例患者术后均获得了良好的血流动力学效果 ,LVOTPG较术前下降达 50 %以上。

    结论 应用 MCE指导 PTSMA治疗术的定位 ,可减少因盲目消融所导致的心肌损伤。

    【关键词】 超声心动描记术;造影剂;心肌病 ,肥大性;导管消融术

    The effect of myocardial contra st echocardiography in percutaneous transluminal septal myocardial ablation in

    patients with hypertrophic obstructive cardiomyopathy L UA N S hurong

    3

    , L I Zhian , HE Yihua , et

    al .

    3

    Department of Ul t rasonography , Beijing A nz hen Hospi tal , Capital University of Medical Science , Beijing

    100029 , China

    【Abstract】 Objective To evaluate the value of myocardial cont rast echocardiography (MCE) in percutaneous

    t ransluminal septal myocardial ablation (PTSMA) in patients with hypert rophic obst ructive cardiomyopathy (HOCM) .

    Methods Thirty2two patients with HOCM were enrolled , and echocardiography was used to help to orient before

    PTSMA. If the enhancement region was consent with the target area ( the base of the sepal which leads to the

    obst ruction of left vent ricular outflow t ract) confirmed pre2PTSMA ,the target blood vessels were tested by obst ructing

    them with balloon. If the pressure gradient decreased ,which indicated that the se ptal branch was the right one ,then the

    pure alcohol was injected to the target vessel . If not ,other septal branches would be selected.Re sults The enhancement

    region was consistent with the area confirmed before o peration in 24 patients , who underwent direct ablation.

    Opacification area was too limited in 5 patients (1 in left vent ricle subendocardium near intervent rise ptum ,1 in middle

    intervent riseptum near right vent ricle ,1 in right vent ricle near modulate band) . The cont rast was developed in non2

    target area in 3 patients who were given up. Twenty2nine patients showed good homodynamic effect . The patients

    showed good effect whose pressure gradient of left vent ricle dropped over 50 per cent . Conclusions MCE is very helpful

    in selecting the septal branch in PTSMA. It can also hel p to decide the scope ,which will be , inf racted which will

    decrease the myocardial injury and complication. In all ,MCE can direct the PTSMA.

    【Key words】 Echocardiography ;Cont rast media ;Cardiomyopathy ,hypert rophic ;Catheter ablation

    非对称性室间隔肥厚导致收缩期左室流出道(lef t

    vent ricular outflow t ract ,LVOT)狭窄是典型肥厚性梗

    阻型心肌病( hypert rophic obst ructive cardiomyopathy ,HOCM)的主要特征。为缓解 LVOT 梗阻 ,近年来出

    现的 应 用 经 皮 经 冠 状 动 脉 心 肌 化 学 消 融 术

    (percutancous t ransluminal septal myocardial ablation ,PTSMA) ,成功地治疗了症状严重的 HOCM 患者 ,使

    其症状和血流动力学状态得到显著改善。PTSMA 术

    中应用心肌声学造影超声心动图(myocardial cont rast

    echocardiographgy ,MCE)以确定靶血管 - 间隔支动脉

    血管与消融心肌之间的关系 ,具有定位的作用。本院

    应用 MCE引导 PTSMA 治疗 HOCM 患者 ,取得了较

    好的临床效果。

    · 907 · 中华超声影像学杂志2002 年12 月第11 卷第12 期 Chin J Ult rasonogr ,December 2002 ,Vol 11 ,No. 12

    ? 1995-2005 Tsinghua Tongfang Optical Disc Co., Ltd. All rights reserved.资 料 与 方 法

    一、研究对象

    自 1998 年 12 月至 2002 年 3 月期间 ,应用 MCE

    引导 PTSMA 治疗 HOCM 患者 32 例 ,其中男 20 例 ,女 12 例 ,年龄 15～71 岁 ,平均 44 岁 ......