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目的 探讨选择性靶血管心肌超声造影在肥厚型梗阻性心肌病室间隔心肌化学消融术中选择靶血管、判断消融范围、防止并发症中的作用。方法 肥厚型梗阻性心肌病37例,室间隔心肌化学消融术中向拟定的靶血管远端注入心肌超声造影剂后即刻和注入无水酒精后5min,超声记录心尖四腔观、胸骨旁左室长轴观、左室短轴观,观察造影剂显影范围、比较造影剂显影范围和无水酒精显影范围。结果 37例患者中2例因冠状动脉血流显像技术显示无合适血管以供消融,而放弃心肌超声造影及消融治疗, 2例因冠状动脉造影显示冠状动脉分布细小弥漫而放弃治疗,未行心肌超声造影。33例行心肌超声造影的患者, 1例因左心室乳头肌显影、1例因右室调节束及右室乳头肌显影、1例因显影范围不在靶域、2例因显影范围过大放弃消融治疗。余28例均成功消融,术后即刻及术后7d,左室流出道压力阶差下降≥50%。部分病例显示无水酒精的显影范围小于心肌超声造影的显影范围。结论 心肌超声造影可为肥厚型梗阻性肌化学消融间隔支靶血管的选择及消融范围的判断提供可靠的依据。
Objective To explore the role of selective target vessel myocardial contrast echocardiography in the selection of target vessels in hypertrophic cardiomyoplasty with myocardial septal myocardial ablation and to determine the extent of ablation and prevent complications. Methods Hypertrophic obstructive cardiomyopathy was observed in 37 cases of hypertrophic obstructive cardiomyopathy. The myocardial venous septum was immersed in the proposed target vessel immediately after the infusion of myocardial contrast agent and 5 minutes after injection of anhydrous alcohol. Long axis view, left ventricular short axis view, observe the contrast agent development range, compare the contrast agent development range and anhydrous alcohol development range. Results Of the 37 patients, 2 patients underwent coronary angiography to show no suitable blood vessels for ablation, and gave up myocardial contrast echocardiography and ablation. Two patients who gave up treatment due to coronary angiography showed small and diffuse distribution of coronary arteries. Myocardial contrast echocardiography. Among the 33 patients who underwent CEUS, one developed left ventricular papillary muscle, one developed right ventricular adjustment bundle and right ventricular papillary muscle. One patient was out of target range because of the imaging range and two patients were ablated due to over-imaging range treatment. The remaining 28 cases were successfully ablated, immediately after surgery and 7d after surgery, left ventricular outflow tract pressure gradient decreased ≥ 50%. In some cases, the development range of anhydrous ethanol is smaller than that of myocardial contrast echocardiography. Conclusions Myocardial contrast echocardiography can provide a reliable basis for the selection of target vessel and the scope of ablation for hypertrophic obstructive muscular ablation.