[1]邓丹,孟璟,曲小龙,等.室间隔化学消融术治疗肥厚型梗阻性心肌病的临床疗效分析[J].第三军医大学学报,2017,39(16):1673-1678.
 DENG Dan,MENG Jing,QU Xiaolong,et al.Clinical efficacy and safety of alcohol septal ablation for hypertrophic obstructive cardiomyopathy[J].J Third Mil Med Univ,2017,39(16):1673-1678.
点击复制

室间隔化学消融术治疗肥厚型梗阻性心肌病的临床疗效分析(/HTML )
分享到:

《第三军医大学学报》[ISSN:1000-5404/CN:51-1095/R]

卷:
39卷
期数:
2017年第16期
页码:
1673-1678
栏目:
临床医学
出版日期:
2017-08-30

文章信息/Info

Title:
Clinical efficacy and safety of alcohol septal ablation for hypertrophic obstructive cardiomyopathy
作者:
邓丹孟璟曲小龙王文婷周杨肇炜博宋治远胡厚源
第三军医大学西南医院:心血管内科,重庆市介入心脏病学研究所,超声诊断科
Author(s):
DENG Dan MENG Jing QU Xiaolong WANG Wenting ZHOU Yang ZHAO Weibo SONG Zhiyuan HU Houyuan

Department of Cardiology, Chongqing Institute of Interventional Cardiology,  Department of Ultrasonography, Southwest Hospital, Third Military Medical University, Chongqing, 400038, China

关键词:
肥厚型心肌病肥厚型梗阻性心肌病室间隔化学消融术实时三维超声心动图
Keywords:
hypertrophic cardiomyopathy hypertrophic obstructive cardiomyopathy chemical septal ablation real-time three dimensional echocardiography
分类号:
R540.45;R540.46;R542.205
文献标志码:
A
摘要:

目的      评估室间隔化学消融术 (alcohol septal ablation, ASA)治疗肥厚型梗阻性心肌病 (hypertrophic obstructive cardiomyopathy, HOCM)患者的临床疗效和安全性。方法     2001年1月至2015年1月行ASA的成年(≥18周岁)HOCM患者44例。术中实时监测静息和激发状态下的左室流出道压力阶差 (left ventricular outflow tract gradient, LVOTG),并于术后3 d,1、3、6、12、24个月采用超声心动图检测室间隔厚度、左室射血分数、二尖瓣反流程度、左房和左室容积、估测静息状态下LVOTG值,以及心功能状态、并发症和死亡率情况。结果     44例HOCM患者ASA术后即刻,静息LVOTG由术前(79.9±37.9)mmHg下降至(33.8±30.2)mmHg (P<001),激发LVOTG由术前(112.4±43.8)mmHg下降至(36.8±30.0)mmHg(P<001)。术后常规给予β受体阻滞剂,术后6个月随访结果显示,舒张末期左房容积由术前(113.8±50.3)mL下降至(97.6±45.7)mL(P<001),收缩末期或舒张末期左室容积均有明显增加,左室各节段收缩同步性升高,NYHA心功能分级有明显改善,且未出现严重并发症。结论      室间隔化学消融术治疗HOCM的安全性高,疗效显著,结合药物治疗可使患者长期获益。

Abstract:

Objective     To evaluate the clinical efficacy and safety of alcohol septal ablation (ASA) in the treatment of hypertrophic obstructive cardiomyopathy (HOCM).  Methods     Forty-four patients with HOCM undergoing ASA between January, 2001 and January, 2015 were enrolled in this analysis. Catheter technique was used to assess the resting and provoked left ventricular outflow tract gradient (LVOTG) in the patients. Echocardiography was performed at different time points after ASA to assess changes in the resting LVOTG, interventricular septum (IVS), left ventricular ejection fraction (LVEF), mitral regurgitation, left atrial volume (LAV), and left ventricular volume, and the changes of New York Heart Association (NYHA) functional class, and incidence of complications and mortality rate of the patients were recorded after the operation. Results     Catheter measurements showed that both the resting and provoked LVOTG were decreased immediately after ASA from 79.9±37.9 mmHg to 33.8±30.2 mmHg (P<0.01) and from 112.4±43.8 mmHg to 36.8±30.0 mmHg (P<0.01), respectively. β-blocker was prescribed for routine treatment for all patients after ASA. At 6 months after ASA, the patients showed a significant reduction of the left atrial enddiastolic volume from 113.8±50.3 mL to 97.6±45.7 mL (P<0.01) with increased left ventricular volume and improved left ventricular synchronism and NYHA cardiac function. No episodes of complete atrioventricular block, ventricular fibrillation, or sudden cardiac death occurred in these patients after the operation. Conclusion     ASA is safe and effective for treatment of HOCM in patients with suitable first septal perforator artery, and postoperative medication with β-blockers can provide the patients with long-term benefits.

参考文献/References:

[1]GERSH B J, MARON B J, BONOW R O, et al. 2011 ACCF/AHA guideline for the diagnosis and treatment of hypertrophic cardiomyopathy: executive summary: a report of the american college of cardiology foundation/american heart association task force on practice guidelines[J]. Circulation,2011,124(24): 2761-2796. DOI: 10.1161/ CIR.0b013e318223e230.
[2]CHOUDHURY L, RIGOLIN V H, BONOW R O. Integrated imaging in hypertrophic cardiomyopathy[J]. Am J Cardiol, 2017, 119(2): 328-339. DOI: 10.1016/j.amjcard.2016.09.033.
[3]CARDOSO B, GOMES I, LOUREIRO P, et al. Clinical and genetic diagnosis of familial hypertrophic cardiomyopathy: results in pediatric cardiology[J]. Rev Port Cardiol, 2017, 36(3): 155-165. DOI: 10.1016/j.repc. 2016.09.009.
[4]HO C Y. Hypertrophic cardiomyopathy in 2012[J]. Circulation, 2012, 125(11): 1432-1438. DOI: 10.1161/ CIRCULATIONAHA.110.017277.
[5]VESELKA J, LAWRENZ T, STELLBRINK C, et al. Low incidence of procedurerelated major adverse cardiac events after alcohol septal ablation for symptomatic hypertrophic obstructive cardiomyopathy[J]. Can J Cardiol, 2013, 29(11): 1415-1421. DOI: 10.1016/j.cjca. 2013.04.027.
[6]SIGWART U. Nonsurgical myocardial reduction for hypertrophic obstructive cardiomyopathy[J]. Lancet, 1995, 346(8969): 211-214. DOI: 10.1016/S0140-6736(95)91267-3.
[7]AGARWAL S, TUZCU E M, DESAI M Y, et al. Updated metaanalysis of septal alcohol ablation versus myectomy for hypertrophic cardiomyopathy[J]. J Am Coll Cardiol, 2010, 55(8): 823-834. DOI: 10.1016/j.jacc. 2009.09.047.
[8]JENSEN M K, ALMAAS V M, JACOBSSON L, et al. Longterm outcome of percutaneous transluminal septal myocardial ablation in hypertrophic obstructive cardiomyopathy: a scandinavian multicenter study[J]. Circ Cardiovasc Interv, 2011, 4(3): 256-265. DOI: 10.1161/ CIRCINTERVENTIONS.110.959718.
[9]CHAMNARNPHOL N, WISARATAPONG T, CHEEWATANAKORNKUL S. Alcohol septal ablation without myocardial contrast echocardiography for hypertrophic obstructive cardiomyopathy[J]. J Med Assoc Thai, 2011, 94(11): 1299-1303.
[10]MENG J, QU X, HUANG H, et al. Intracoronary electrocardiogram during alcohol septal ablation for hypertrophic obstructive cardiomyopathy predicts myocardial injury size[J]. Clin Exp Pharmacol Physiol, 2016, 43(1): 75-80. DOI:10.1111/1440-1681.12502.
[11]SORAJJA P, VALETI U, NISHIMURA R A,et al. Outcome of alcohol septal ablation for obstructive hypertrophic cardiomyopathy[J]. Circulation,2008 ,118(2): 131-139. DOI: 10.1161/CIRCULATIONAHA. 107.738740.
[12]胡厚源, 何国祥, 周林, 等. 经皮间隔心肌消融术治疗3例肥厚型梗阻性心肌病[J]. 第三军医大学学报, 2004, 26(11): 1002-1004. DOI: 10.16016/j.10005404. 2004.11.023.
HU H Y, HE G X, ZHOU L, et al. Treatment for hypertrophic obstructive cardiomyopathy by percutaneous transluminal septal myocardial ablation [J]. J Third Mil Med Univ, 2004, 26(11): 1002-1004.DOI:10. 16016/ j.10005404.2004.11.023.
[13]SEN-CHOWDHRY S, JACOBY D, MOON J C, et al. Update on hypertrophic cardiomyopathy and a guide to the guidelines[J]. Nat Rev Cardiol, 2016, 13(11): 651-675. DOI: 10.1038/nrcardio.2016.140.
[14]FRAICHE A,WANG A.Hypertrophic cardiomyopathy: new evidence since the 2011 american cardiology of cardiology foundation and american heart association guideline[J]. Curr Cardiol Rep, 2016, 18(8): 70. DOI: 10.1007/s11886- 016-0751-8.
[15]Authors/Task Force Members, ELLIOTT P M, ANASTASAKIS A, et al. 2014 ESC guidelines on diagnosis and management of hypertrophic cardiomyopathy: the task force for the diagnosis and management of hypertrophic cardiomyopathy of the european society of cardiology (ESC)[J]. Eur Heart J, 2014, 35(39): 2733-2779. DOI: 10.1093/eurheartj/ ehu284.
[16]VESELKA J, TOMAOV P, ZEMNEK D. Longterm effects of varying alcohol dosing in percutaneous septal ablation for obstructive hypertrophic cardiomyopathy: a randomized study with a followup up to 11 years[J]. Can J Cardiol, 2011, 27(6): 763-767. DOI: 10.1016/ j.cjca.2011.09.001.
[17]VESELKA J, LAWRENZ T, STELLBRINK C, et al. Early outcomes of alcohol septal ablation for hypertrophic obstructive cardiomyopathy: a european multicenter and multinational study[J]. Catheter Cardiovasc Interv, 2014, 84(1): 101-107. DOI: 10.1002/ccd.25236.
[18]CHEN S L, YE F, XU Z L, et al. Midterm outcomes of percutaneous transluminal septal myocardial ablation in patients with hypertrophic obstructive cardiomyopathy refractory to medication[J]. Chin Med J, 2006, 119(13): 1121-1124.
[19]GIMENO J R, TOM-M T, MCKENNA W J. Alcohol septal ablation in hypertrophic cardiomyopathy: an opportunity to be taken[J]. Rev Esp Cardiol (Engl Ed), 2012, 65(4): 314-318. DOI:10.1016/j.recesp. 2011.11.021.
[20]黄海韵, 郭燕丽, 孟璟, 等. 斑点追踪成像在肥厚型梗阻性心肌病患者室间隔化学消融术后随访中的应用价值[J]. 第三军医大学学报, 2015, 37(18): 1859-1863. DOI:10.16016/j.10005404.201506110.
HUANG H Y, GUO Y L,MENG J,et al.Value of speckle tracking imaging in postoperative followup of alcohol septal ablation for hypertrophic obstructive cardiomyopathy: report of 19 cases[J]. J Third Mil Med Univ, 2015, 37(18): 1859-1863. DOI: 10.16016/j.1000-5404.201506110.
[21]SADAT K, DIDDI H P, KLAS B, et al. Live/real time threedimensional transesophageal echocardiographic assessment of ventricular septal volume and mass before and after myectomy in hypertrophic cardiomyopathy[J]. Echocardiography, 2013, 30(10): 1227-1231. DOI: 10. 1111/echo.12375.
[22]STEENDIJK P, MELIGA E, VALGIMIGLI M, et al. Acute effects of alcohol septal ablation on systolic and diastolic left ventricular function in patients with hypertrophic obstructive cardiomyopathy[J]. Heart, 2008, 94(10): 1318-1322. DOI: 10.1136/hrt.2007.139535.
[23]TANI T, YAGI T, KITAI T, et al. Left atrial volume predicts adverse cardiac and cerebrovascular events in patients with hypertrophic cardiomyopathy[J]. Cardiovasc Ultrasound, 2011, 9: 34. DOI: 10.1186/1476-7120-9-34.
[24]KUHN H, LAWRENZ T, LIEDER F, et al. Survival after transcoronary ablation of septal hypertrophy in hypertrophic obstructive cardiomyopathy (TASH): a 10 year experience[J]. Clin Res Cardiol, 2008, 97(4): 234-243. DOI: 10.1007/s00392-007-0616-7.
[25]LAWRENZ T, BORCHERT B, LEUNER C, et al. Endocardial radiofrequency ablation for hypertrophic obstructive cardiomyopathy: acute results and 6 months’ follow-up in 19 patients[J]. J Am Coll Cardiol, 2011, 57(5): 572-576.  DOI: 10.1016/j.jacc.2010.07.055.

相似文献/References:

[1]黄海韵,郭燕丽,孟璟,等.斑点追踪成像在肥厚型梗阻性心肌病患者室间隔酒精消融术后随访中的应用价值[J].第三军医大学学报,2015,37(18):1859.
 Huang Haiyun Guo Yanli,Meng Jing,Hu Houyuan,et al.Value of speckle tracking imaging in postoperative follow-up of alcohol septal ablation for hypertrophic obstructive cardiomyopathy: report of 19 cases[J].J Third Mil Med Univ,2015,37(16):1859.

更新日期/Last Update: 2017-08-23