摘要
目的:评估经导管弹簧圈栓塞术对肥厚型梗阻性心肌病（HOCM）的临床疗效及长期随访。方法:回顾性的分析了2017年6月至2018年6月期间于陆军特色医学中心心内科住院并成功行间隔支弹簧圈栓塞的HOCM患者共3例。分析患者的一般情况，术中测压、血管栓塞以及患者长期随访中的症状及超声心动图评估的室间隔厚度及左室流出道与主动脉峰值压力阶差（LVOTG）变化情况。结果:所有患者术前均表现为不同程度的气促、胸闷等症状。3例患者有创测压LVOTG均大于50 mmHg（1 mmHg=0.133 kPa）。经成功栓塞间隔支后，所有患者即刻造影结果均提示靶血管栓塞效果良好，术中及术后均无明显的高度房室传导阻滞发生。术后即刻效果除病例1欠满意外，病例2中LVOTG由栓塞前的94 mmHg下降至8 mmHg，病例3由99 mmHg降低至32 mmHg。病例1术中LVOTG下降不满意，术后2月猝死。另两例患者术后症状均有所缓解，但随着时间的推移，术后室间隔厚度及LVOTG均有所恢复，但仍低于栓塞前。结论:HOCM经弹簧圈栓塞间隔支安全、有效，但长期随访有一定程度的恢复。
Abstract
Objective:To evaluate the safety and long-term clinical efficacy of coil embolization of the septal perforator in patients with hypertrophic obstructive cardiomyopathy (HOCM).Methods:Data of three HOCM patients who received coil embolization of the septal perforator from June 2017 to June 2018 at Army Medical Center were retrospectively collected. The baseline characteristics, symptoms, left ventricular outflow tract gradient (LVOTG), and maximum interventricular septum thickness before and after the procedure were recorded for analysis.Results:All the patients complained of varying degrees of dyspnea and chest distress and the LVOTG was higher than 50 mmHg (1 mmHg=0.133 kPa) in all cases. The septal perforator was successfully embolized with coil and demonstrated by target artery angiography without the occurrence of high degree atrioventricular block. The LVOTG was significantly reduced after the procedure except case 1. The LVOTG of case 1 failed to improve and sudden death occurred 2 months after discharge. The symptoms of the other two cases were all relieved but during the long-term follow up, an increase in the LVOTG and maximum interventricular septum thickness was observed.Conclusion:The results of this pilot study suggest that coil embolization of the septal perforator is feasible and safe but long-term follow-up showed an increase in the LVOTG and maximum interventricular septum thickness to some extent.
万方数据