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題名 | 經皮穿腔中膈心肌血管栓塞術對阻塞性肥厚心肌症之應用=Percutaneous Transluminal Septal Myocardial Ablation in Hypertrophic Obstructive Cardiomyopathy |
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作者 | 蔡佶祜; 方志元; 林松水; 張崴棣; | 書刊名 | 中華放射線技術學雜誌 |
卷期 | 33:2 2009.12[民98.12] |
頁次 | 頁105-110 |
分類號 | 415.3165 |
關鍵詞 | 阻塞性肥厚心肌症; 經皮穿腔中膈心肌血管栓塞術; 酒精燒灼; HOCM; PTSMA; Hypertrophic obstructive cardiomyopathy; Percutaneous transluminal septal myocardial ablation; Alcoholic ablation; |
語文 | 中文(Chinese) |
中文摘要 | 肥厚性心肌症(hypertrophic cardiomyopathy; HCM)病人中大約有25%屬於會產生左心室出口通道壓力差(left ventricular outflow tract pressure gradient)的阻塞性肥厚心肌症(hypertrophic obstructive cardiomyopathy; HOCM)。大約有5%的HOCM病人對藥物治療方面較差反應不佳。這一類病人在80年代以前只能以心室中隔心肌切除術(septal myectomy)來改善心衰竭。Sigwart於1995年提出以經皮穿腔中膈心肌血管栓塞術(percutaneous transluminal septal myocardial ablation; PTSMA)經心導管的方式來改善其症狀。PTSMA是透過導管內腔注射0.8~1.5ml的99.5%酒精對病灶血管進行酒精燒灼,可快速地降低左心室出口通道的壓力差。在接受本項手術後若其壓力差降低至原來的50%以下,則代表為治療成功。自2001年4月起至2008年1月有11名病例接受手術,平均年齡為58.7歲(±10.9歲)。術中發生房室阻斷有2例。治療前後左心室出口通道平均壓力差為113.3mmHg(±48.2mmHg)及26.9mmHg(±13.6mmHg)(p<0.001)。治療前後中膈心肌厚度21.4mm(±5.9mm)及18.3mm(±4.5mm)(p<0.05)。治療後肌酸激酶檢驗值為(creatine kinase; CK)1064.4U/L(±468.4U/L);治療後肌酸激酶同功酶檢驗值為(creatine kinase isoenzymes-MB; CKMB)162.9U/L(±101.6U/L)。冠狀動脈心肌栓塞術的發展至今己逾十年,大多數皆可改善其壓力差達到治療效果,不過是否能像心肌切除術一樣可以維持數十年之久還有待觀察。目前在世界各地己施行PTSMA達三仟多病例,此治療方式己成為目前對藥物反應不佳的病人成為另一選擇的治療方式。 |
英文摘要 | Hypertrophic obstructive cardiomyopathy (HOCM) might induce left ventricular outflow tract obstruction to get pressure gradient seen in approximately 25% of cases with hypertrophic cardiomyopathy; HCM. Medical therapy was ineffective in about 5% patients. This patient group received septal myectomy operation and had heart failure improvement before 1980 era. Sigwart developed percutaneous transluminal septal myocardial ablation (PTSMA) techniques for symptoms improvement in 1995. By injecting 0.8-1.5ml 99.5% alcohol into the treated vessel to ablate septal myocardium; reduced left ventricular out flow tract pressure. A 50% pressure gradient reduction was the therapeutic goal of this technique. There were 11 consecutive cases received PTSMA between April, 2001 and January, 2008. At our institute, the mean age was 58.7 years old (±10.9). Two cases developed atrioventricle block during this procedure. Mean pressure gradient reduced from 113.3mmHg (±48.2mmHg) to 26.9mmHg (±13.6mmHg) after this procedure (p<0.001). Thickness of septal myocardium decreased from 21.4mm to 18.3mm after treatment (p<0.05). Mean Creatine kinase was 1064.4U/L (±468.4U/L) and Creatine kinase isoenzymes-MB was 162.9U/L (±101.6 U/L) after treatment. Clinical application of PTSMA was over a decade, but it was still controversy on long term result. So far, there were more than 3,000 cases reported in the worldwide. PTSMA was an alternative treatment option for HOCM patients with poor medical control. |
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