论文部分内容阅读
目的:分析总结肥厚型心肌病合并左心室心尖部室壁瘤患者的临床特征。方法:2007-01至2013-01共1 194例肥厚型心肌病患者在北京同仁医院接受检查,其中23例(1.94%)合并左心室心尖部室壁瘤,男19例,女4例。所有患者均除外冠心病,并接受超声心动图和心血管造影检查。结果:23例患者中,左心导管检查证实其中21例患者左心室中部存在梗阻,其中7例患者同时合并左心室流出道梗阻。21例左心室梗阻患者收缩期压差为(56.8±12.9)mm Hg(1 mm Hg=0.133 k Pa);另外2例患者为心尖肥厚型心肌病。患者的左心室室壁最大厚度为(21.8±6.3)mm,左心室横径(39.4±5.2)mm。心电图检查提示,3例患者合并阵发性室性心动过速。心血管造影检查发现,6例患者合并冠状动脉肌桥,并且均位于冠状动脉前降支。(2.7±1.3)年随访过程中,5例患者发生心血管不良事件,其中2例患者充血性心力衰竭加重,3例患者发生室性心动过速。结论:肥厚型心肌病伴发左心室心尖部室壁瘤最常见于左心室中部肥厚型梗阻性心肌病患者,其中部分患者同时合并左心室流出道梗阻。这些患者心血管不良事件发生率高,早期准确诊断对指导临床治疗至关重要。
Objective: To analyze the clinical features of patients with hypertrophic cardiomyopathy complicated by left ventricular apex aneurysm. METHODS: A total of 1 194 patients with hypertrophic cardiomyopathy were examined at Beijing Tongren Hospital from January 2007 to January 2013, of which 23 (1.94%) had left ventricular apical aneurysm, 19 males and 4 females. All patients except for coronary heart disease and echocardiography and cardiovascular imaging. RESULTS: Of the 23 patients, left heart catheterization confirmed the presence of obstruction in the middle of the left ventricle in 21 of 21 patients, and in 7 of 7 patients, the obstruction of left ventricular outflow tract was also combined. The systolic pressure difference was (56.8 ± 12.9) mm Hg (1 mm Hg = 0.133 kPa) in 21 patients with left ventricular obstruction. The other 2 patients were apical hypertrophic cardiomyopathy. The maximum thickness of the left ventricular wall was (21.8 ± 6.3) mm and the diameter of the left ventricle (39.4 ± 5.2) mm. ECG examination prompts, 3 patients with paroxysmal supraventricular tachycardia. Cardiac angiography showed that 6 patients had coronary muscle bridge, and all located in the anterior descending coronary artery. During the follow-up of 2.7 ± 1.3 years, 5 patients developed cardiovascular adverse events, including 2 patients with congestive heart failure and 3 patients with ventricular tachycardia. Conclusions: Hypertrophic cardiomyopathy with left ventricular apical aneurysm is the most common type of patients with hypertrophic obstructive cardiomyopathy in the middle of the left ventricle. Some of them are complicated by left ventricular outflow tract obstruction. The incidence of cardiovascular adverse events in these patients is high, accurate early diagnosis is essential to guide the clinical treatment.