CAJ | 학술논문

目的探索经皮室间隔心肌隧道化学消融术(PTSTMA)治疗用传统技术治疗不适合的肥厚梗阻型心肌病(HOCM)的方法及疗效.方法以稍大于冠状动脉室间隔支直径型号的monorail球囊扩张至后间隔基底段,换成再大一号的OTW球囊继续扩张建造“室间隔隧道”,并注入无水酒精进行化学消融,用相同方法进行第二或第三间隔支；以左心室流出道压力阶差下降≥50％为终点.观察经PTSTMA治疗的26例HOCM患者术后即刻及近中期的随访资料.结果 26例静息左心室流出道压力阶差下降≥50％,术前静息左心室流出道压力阶差(75.6±22.4) mm Hg,术后即刻下降至(21.4±5.8)mm Hg(t=11.94,P＜0.01)；消融术前室间隔厚度(22.8±5.8) mm,术后3个月降至(16.8±4.2) mm(t=4.27,P＜0.01)；左心房内径术前(48.0±7.0) mm,术后3个月降至(42.0±8.6) mm(f=2.76,P＜0.01).与术前比较,6.0 ～60.0个月随访中胸痛[53.8％(14/26)与15.4％(4/26),x2=8.49,P＜0.01]、呼吸困难[100％ (26/26)与(19.2％ (5/26),x2=35.22,P＜0.01]症状明显减轻；NYHA心功能分级术前为2.4±0.6,术后半年为1.4±0.7,心功能有显著改善(t=5.53,P＜0.01).结论 PTSTMA是HOCM心肌化学消融术的一种补充方法,近、中期安全有效.
목적 탐색경피실간격심기수도화학소융술(PTSTMA)치료용전통기술치료불괄합적비후경조형심기병(HOCM)적방법급료효.방법 이초대우관상동맥실간격지직경형호적monorail구낭확장지후간격기저단,환성재대일호적OTW구낭계속확장건조“실간격수도”,병주입무수주정진행화학소융,용상동방법진행제이혹제삼간격지；이좌심실류출도압력계차하강≥50％위종점.관찰경PTSTMA치료적26례HOCM환자술후즉각급근중기적수방자료.결과 26례정식좌심실류출도압력계차하강≥50％,술전정식좌심실류출도압력계차(75.6±22.4) mm Hg,술후즉각하강지(21.4±5.8)mm Hg(t=11.94,P＜0.01)；소융술전실간격후도(22.8±5.8) mm,술후3개월강지(16.8±4.2) mm(t=4.27,P＜0.01)；좌심방내경술전(48.0±7.0) mm,술후3개월강지(42.0±8.6) mm(f=2.76,P＜0.01).여술전비교,6.0 ～60.0개월수방중흉통[53.8％(14/26)여15.4％(4/26),x2=8.49,P＜0.01]、호흡곤난[100％ (26/26)여(19.2％ (5/26),x2=35.22,P＜0.01]증상명현감경；NYHA심공능분급술전위2.4±0.6,술후반년위1.4±0.7,심공능유현저개선(t=5.53,P＜0.01).결론 PTSTMA시HOCM심기화학소융술적일충보충방법,근、중기안전유효.
Objective To explore the method and efficiency of percutaneous transluminal septal tunnet myocardial ablation(PTSTMA) in treatment of 26 cases hypertrophic obstructive cardiomyopathy (HOCM) who were not suitable for conventional technology.Methods Firstly,we used a monorail Balloon which was slightly bigger than the interventricular septal branch of coronary artery and dilated it until posterior septal.After that,an OTW Balloon with larger size than the monorail was used to dilate again until made a " ventricular septum tunnel".Then,some alcohol was injected and PTSTMA was performed.Finally,we did the other and/or another interventricular septal branch by above method until the left ventricular outflow tract pressure gradient (LVOTPG) reduced ≥50％.The clinical indexes of the 26 cases HOCM immediately pest-operation of PTSTMA were observed and the follow up data during short term and metaphase were analyzed.Results The LVOTPG reduced ≥50％ in the26 cases HOCM,immediately after PTSTMA,the LVOTPG reduced from (75.6 ±22.4)mm Hg to (21.4 ± 5.8) mm Hg (t =11.94,P ＜ 0.01).At three months after ablation,the thickness of septal myocardium reduced from (22.8 ± 5.8) ram before ablation to (16.8 ± 4.2) mm(t =4.27,P ＜ 0.01),left atrium dimension reduced from(48.0 ±7.0) mm to (42.0 ±8.6) mm (t =2.76,P ＜0.01).Followed up 6.0to 60.0 months,the patients suffering from chest pain reduced from 14 cases before to 4 cases after the procedure(53.8％ (14/26) vs 15.4％ (4/26),x2 =8.49,P ＜ 0.01),the patients with expiratory dyspnea reduced from 26 cases to 5 cases(100％ (26/26) vs 19.2％ (5/26),x2 =35.22,P ＜ 0.01),NYHA functional class improved from (2.4 ± 0.6) to (1.4 ± 0.7) (t =5.53,P ＜ 0.01).Conclusion The PTSTMA was a supplemental method of PTSMA on treating HOCM,which was safe and useful during the short term and metaphase.