合并感染性心内膜炎肥厚梗阻性心肌病的外科治疗

Surgical Treatment for Hypertrophic Obstructive Cardiomyopathy Complicated by Infective Endocarditis

目的探讨合并感染性心内膜炎的肥厚梗阻性心肌病(hypertrophic obstructive cardiomyopathy,HOCM)患者的手术方式及疗效。方法回顾性分析2006年9月至2012年2月阜外心血管病医院采用扩大Morrow手术+心内赘生物清除术+受累心瓣膜置换术治疗7例合并感染性心内膜炎HOCM患者的临床资料,其中男5例,女2例;年龄21～55(39.80±13.60)岁。术后观察手术疗效,比较手术前后的左心室流出道(LVOT)峰值压差、左心房内径、左心室射血分数和心功能。结果手术成功率100%,围术期无死亡。细菌性赘生物位于二尖瓣瓣叶7例、主动脉瓣瓣叶4例、室间隔1例;均为多发性,赘生物直径2～19 mm。血培养金黄色葡萄球菌生长3例、松鼠葡萄球菌生长1例。术后发生Ⅰ°房室传导阻滞2例、完全性左束支传导阻滞1例、左前分支传导阻滞2例,未予特殊处理。术后LVOT峰值压差、左心房内径均低于或小于术前;心功能较术前明显改善。7例患者均获得随访,随访时间1～49(13.00±17.19)个月,所有患者临床症状消失或明显减轻,生活质量明显改善,心功能分级(NYHA)Ⅰ～Ⅱ级,无再次手术或死亡。结论扩大Morrow手术+受累心瓣膜置换术治疗合并感染性心内膜炎HOCM患者,其早中期疗效满意。

Objective To analyze surgical procedures and clinical outcomes for patients with hypertrophic obstructive cardiomyopathy（HOCM） complicated by infective endocarditis.Methods We retrospectively analyzed clinical data of 7 patients with HOCM complicated by infective endocarditis who underwent modified Morrow procedure,removal of intracardiac vegetation,and valve replacement in Fu Wai Hospital from Sep.2006 to Feb.2012.There were 5 male patients and 2 female patients with their mean age of 39.80±13.60 years（ranging 21-55）.Postoperative clinical outcomes were observed.Preoperative and postoperative left ventricular outflow tract（LVOT） gradients,left atrium（LA） diameter,left ventricular ejection fraction（LVEF） and heart function were compared.Results There was no in-hospital death and perioperative survival rate was 100% in this group.Bacteria vegetations were multiply detected on the mitral valve leaflet （7 cases）,aortic valve leaflet（4 cases） and ventricular septum（1 case） with their diameter of 2-19 mm.Blood culture showed Staphylococcus aureus（3 cases）,Squirrel aureus（1 case）.Postoperatively,first-degree atrioventricular block occurred in 2 patients,complete left bundle branch block in 1 patient,left anterior division block in 2 patients,and all these complications were not treated.Postoperative LVOT gradient and LA diameter were significantly lower than preoperative values（P0.05）,and cardiac function was significantly improved in these patients.All the patients underwent transthoracic echocardiography at a mean follow-up of 13.00±17.19（1-49） months in outpatient service.The clinical symptoms of all these patients were diminished or significantly ameliorated and their quality of life was considerably improved.All the patients had NYHA classⅠorⅡ without any reintervention or death during follow-up.Conclusion Modified Morrow procedure and valve replacement is a good surgical strategy for patients with HOCM complicated by infective endocarditis with satisfactory early and mid-term clinical outcomes.