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中华临床医师杂志(电子版) ›› 2023, Vol. 17 ›› Issue (01) : 68 -71. doi: 10.3877/cma.j.issn.1674-0785.2023.01.012

临床研究

间隔支弹簧圈栓塞术对肥厚型梗阻性心肌病的临床疗效及远期随访
李传伟1, 文倩2, 罗浩2,()   
  1. 1. 400042 重庆,陆军特色医学中心(陆军军医大学大坪医院)心血管内科
  • 收稿日期:2021-11-24 出版日期:2023-01-15
  • 通信作者: 罗浩

Long-term clinical efficacy and safety of coil embolization of the septal perforator in patients with hypertrophic obstructive cardiomyopathy

Chuanwei Li1, Qian Wen2, Hao Luo2,()   

  1. 1. Department of Cardiology, the Army medical center (Daping Hospital of the Army Medical University), Chongqing 400042, China; The Chongqing Emergency Medical Center, Chongqing 400042, China
    2. Department of Cardiology, the Army medical center (Daping Hospital of the Army Medical University), Chongqing 400042, China
  • Received:2021-11-24 Published:2023-01-15
  • Corresponding author: Hao Luo
引用本文:

李传伟, 文倩, 罗浩. 间隔支弹簧圈栓塞术对肥厚型梗阻性心肌病的临床疗效及远期随访[J]. 中华临床医师杂志(电子版), 2023, 17(01): 68-71.

Chuanwei Li, Qian Wen, Hao Luo. Long-term clinical efficacy and safety of coil embolization of the septal perforator in patients with hypertrophic obstructive cardiomyopathy[J]. Chinese Journal of Clinicians(Electronic Edition), 2023, 17(01): 68-71.

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。

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.

表1 肥厚型梗阻性心肌病患者基本情况
表2 肥厚型梗阻性心肌病患者流出道梗阻随访情况
1
Zou Y, Song L, Wang Z, et al. Prevalence of idiopathic hypertrophic cardiomyopathy in China: a population-based echocardiographic analysis of 8080 adults [J]. Am J Med, 2004, 116(1): 14-18.
2
Durand E, Mousseaux E, Coste P, et al. Non-surgical septal myocardial reduction by coil embolization for hypertrophic obstructive cardiomyopathy: early and 6 months follow-up [J]. Eur Heart J, 2008, 29(3): 348-355.
3
中华医学会心血管病学分会中国成人肥厚型梗阻性心肌病诊断与治疗指南编写组. 2017中国成人肥厚型心肌病诊断与治疗指南 [J]. 中华心血管病杂志, 2017, 45(12): 1015-1032
4
Alashi A, Smedira NG, Hodges K, et al. Outcomes in guideline-based class i indication versus earlier referral for surgical myectomy in hypertrophic obstructive cardiomyopathy [J]. J Am Heart Assoc, 2021,10(1): e016210.
5
Ji Q, Wang YL, Yang Y, et al. Mini-invasive surgical instruments in transaortic myectomy for hypertrophic obstructive cardiomyopathy: a single-center experience with 168 cases [J]. J Cardiothorac Surg, 2021,16(1): 25.
6
Bytyçi I, Nistri S, Mörner S, et al. Alcohol septal ablation versus septal myectomy treatment of obstructive hypertrophic cardiomyopathy: a systematic review and meta-analysis [J]. J Clin Med, 2020, 9(10): 3062.
7
Batzner A, Pfeiffer B, Neugebauer A, et al. Survival after alcohol septal ablation in patients with hypertrophic obstructive cardiomyopathy [J]. J Am Coll Cardiol, 2018, 72(24): 3087-3094.
8
Oto A, Aytemir K, Okutucu S, et al. Cyanoacrylate for septal ablation in hypertrophic cardiomyopathy [J]. J Interv Cardiol, 2011,24(1): 77-84.
9
Guerrero I, Dhoble A, Fasulo M, et al. Safety and efficacy of coil embolization of the septal perforator for septal ablation in patients with hypertrophic obstructive cardiomyopathy [J]. Catheter Cardiovasc Interv, 2016, 88(6): 971-977.
10
Liu F, Fu J, Hsi D, et al. Percutaneous intramyocardial septal radiofrequency ablation for interventricular septal reduction: an ovine model with 1-year outcomes [J]. Cardiology, 2020, 145(1): 53-62.
11
Liu L, Li J, Zuo L, et al. Percutaneous intramyocardial septal radiofrequency ablation for hypertrophic obstructive cardiomyopathy [J]. J Am Coll Cardiol, 2018, 72(16): 1898-1909.
12
Cooper RM, Shahzad A, Hasleton J, et al. Radiofrequency ablation of the interventricular septum to treat outflow tract gradients in hypertrophic obstructive cardiomyopathy: a novel use of CARTOSound® technology to guide ablation [J]. Europace, 2016,18(1): 113-120.
13
Creta A, Elliott P, Earley MJ, et al. Catheter ablation of atrial fibrillation in patients with hypertrophic cardiomyopathy: a European observational multicentre study [J]. Europace, 2021, 23(9): 1409-1417.
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