CAJ | 학술논문

目的评价冠状动脉造影的形态学特征对经皮室间隔心肌化学消融(PTSMA)术治疗肥厚型梗阻性心肌病(HOCM)的指导意义.方法选择32例药物疗效欠佳并行PTSMA手术的HOCM患者,研究其冠状动脉造影特点,并与30例年龄、性别相匹配的冠状动脉造影正常的患者(对照组)进行比较.根据定量冠状动脉造影(QCA)测定目标消融间隔支的直径,分为≤1.5mm(小间隔支组)和>1.5mm组(大间隔支组),比较两组PTSMA术前、术后心导管测量左心室流出道压差(LVOTG)的变化.结果冠状动脉造影显示HOCM组的左主干、左前降支、左回旋支及左间隔支内径均显著大于对照组(均P<0.05),HOCM组左前降支肌桥的发生率较对照组亦明显增加(P<0.05);23例消融成功,PTSMA术前、术后导管测量LVOTG分别为(85.8±31.1)、(37.25±31.9)mmHg(P<0.01),其中大间隔支组PTSMA成功率明显高于小间隔支组(P<0.05),大间隔支组LVOTG的下降程度明显大于小间隔支组(P<0.05),两组间无水乙醇用量差异无统计学意义(P>0.05).结论 HOCM患者的左前降支肌桥发生率增加,且左冠状动脉内径较粗大,尤其是左间隔支粗大;间隔支>1.5mm的HOCM患者是PTSMA手术成功的重要预测因素,这对PTSMA目标消融间隔支的选择具有重要指导意义.
목적평개관상동맥조영적형태학특정대경피실간격심기화학소융(PTSMA)술치료비후형경조성심기병(HOCM)적지도의의.방법선택32례약물료효흠가병행PTSMA수술적HOCM환자,연구기관상동맥조영특점,병여30례년령、성별상필배적관상동맥조영정상적환자(대조조)진행비교.근거정량관상동맥조영(QCA)측정목표소융간격지적직경,분위≤1.5mm(소간격지조)화>1.5mm조(대간격지조),비교량조PTSMA술전、술후심도관측량좌심실류출도압차(LVOTG)적변화.결과관상동맥조영현시HOCM조적좌주간、좌전강지、좌회선지급좌간격지내경균현저대우대조조(균P<0.05),HOCM조좌전강지기교적발생솔교대조조역명현증가(P<0.05);23례소융성공,PTSMA술전、술후도관측량LVOTG분별위(85.8±31.1)、(37.25±31.9)mmHg(P<0.01),기중대간격지조PTSMA성공솔명현고우소간격지조(P<0.05),대간격지조LVOTG적하강정도명현대우소간격지조(P<0.05),량조간무수을순용량차이무통계학의의(P>0.05).결론 HOCM환자적좌전강지기교발생솔증가,차좌관상동맥내경교조대,우기시좌간격지조대;간격지>1.5mm적HOCM환자시PTSMA수술성공적중요예측인소,저대PTSMA목표소융간격지적선택구유중요지도의의.
Objective To investigate the characteristics of coronary angiographic in patients with hypertrophic obstructive cardiomyopathy (HOCM) and its clinical significance for guiding percutaneous transluminal septal myocardial ablation (PTSMA). Methods PTSMA was performed in 32 patients with symptomatic drug-refractory HOCM. The characteristics of coronary an-giography of patients analyzed and compared with those of 30 age- and gender-matched patients with normal coronary an-giography. According to quantitative coronary angiogrophy analysis(QCA), 32 patients were divided into two groups:the diame-ters of target septal branches≤1.5mm (smal septal branch group)and>1.5mm (large septal branch group). Left ventricular outflow-tract gradient (LVOTG) was measured before and after the procedure. Results Coronary angiography showed that the diameters of left main coronary, left anterior descending artery, left circumflex and first septal branch in HOCM group were sig-nificantly larger than those in control group (P<0.05). And the incidence rate of myocardial bridge of left anterior descending artery was significantly higher in HOCM group. PTSMA procedure was successful y achieved in 23 patients. The average LVOTG was 85.8±31.1mmHg before the procedure and 37.25±31.9mmHg after the procedure (P<0.01). PTSMA success rate was significantly higher in large septal branch group (P<0.05). Moreover, the LVOTG decreased more in large septal branch group. But the dose of absolute ethanol used in PTSMA was comparable between these two groups(P>0.05). Conclusion Compared to patients with normal coronary angiography, there is a higher incidence of myocardial bridge of left anterior descending artery and larger diameters of left coronary artery (especial y septal artery) in HOCM patients. The diameter of target septal branch larger than 1.5mm is an important predictor of successful procedure of PTSMA. These findings wil help to guide PTSMA for HOCM patients.