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目的 :通过多普勒超声心动图在肥厚梗阻性心肌病 (HOCM)解剖和形态的不同特点 ,探讨新分型和在经皮室间隔化学消融 (PTSMA)治疗中应用价值。方法 :将我院经 MRI、CT或 /和左心室造影诊断明确HOCM45例患者的超声心动图结果分为 4型 ,即 I型局限主动脉下肥厚梗阻型 ,II型室间隔中部肥厚梗阻为主型 ,III型室间隔弥漫肥厚梗阻型 ,IV型心脏多部位肥厚受累梗阻型 ,并将各型超声心动图特点与临床特点和冠状动脉造影结果进行对照分析。结果 :I型 (8例 )超声心动图显示以流出道梗阻为主要特点 ,临床多以头晕、黑朦和晕厥等脑供血不足为主要表现 ,冠状动脉造影常可见近端主间隔支较大并有肌桥 ,预示 PTSMA效果可能最好 ;II型(11例 )显示以左心室中段梗阻为主的特点 ,临床则以胸闷、胸痛、气短等心脏症状为主要表现 ,冠状动脉造影也可见近中段较大主间隔支和肌桥存在 ,PTSMA对减轻临床心脏表现可能具有意义 ;III型 (10例 )显示室间隔弥漫性梗阻 ,可自室中延续至流出道 ,因此临床上既有脑供血不足表现 ,又有心脏症状、冠状动脉造影常多支间隔支供应梗阻区心肌 ,肌桥存在较弥漫 ,如近端可见较大的主间隔支支配和肌桥存在 ,消融主间隔支对部分消除临床症状可能有益 ,部分患者需二次接受 PTSMA治疗 ;IV型 (16例 )超声心
Objective: To explore the new classification and the value of percutaneous septal chemical ablation (PTSMA) by Doppler echocardiography in the anatomy and morphology of hypertrophic obstructive cardiomyopathy (HOCM). Methods: The results of echocardiography of 45 cases of HOCM diagnosed by MRI, CT and / or left ventricular angiography in our hospital were divided into 4 types, namely type I limited hypertrophy obstruction of the aorta, type II hypertrophy obstruction in the middle of the septum Type III ventricular septal hypertrophy obstruction type, type IV heart hypertrophy affected obstructive type, and all types of echocardiographic features and clinical features and coronary angiography results were analyzed. Results: Echocardiography of type I (8 cases) showed that outflow tract obstruction was the main feature. Most of the clinical manifestations were dizziness, hazyness and fainting. Cerebral angiography showed that the main dural branch was larger Type II (11 cases) showed the characteristics of the middle part of the left ventricle obstruction. The clinical features were chest tightness, chest pain, shortness of breath and other cardiac symptoms as the main performance, coronary angiography can also be seen near the middle PTSMA may have clinical significance in reducing the clinical cardiac manifestations. Type III (10 cases) showed diffuse interventricular septum obstruction, which could extend from the chamber to the outflow tract. Therefore, the clinical manifestations of both cerebral insufficiency , There are heart symptoms, coronary angiography, often multiple branches of the supply of obstructed myocardium, muscle bridge there is more diffuse, such as the proximal end can be seen in the main branch of the main branch and muscle bridge exist, ablation of the main part of the branch on the elimination of clinical symptoms May be beneficial, some patients need to be treated with PTSMA twice; type IV (16 cases) echocardiography