RPR技术治疗复杂肥厚型梗阻性心肌病

Surgical treatment with RPR technique for complex hypertrophic obstructive cardiomyopathy

目的·评价RPR技术治疗复杂肥厚型梗阻性心肌病(HOCM)的临床疗效。方法·2009年6月至2015年12月,采用RPR技术治疗复杂HOCM 9例。其中男性6例,女性3例;年龄22~63岁,平均(43±19)岁。术前经胸超声心动图(TTE)均可见二尖瓣收缩期前向运动(SAM),伴有中度或中度以上的二尖瓣反流(MR)。术中经食管超声心动图(TEE)评估手术效果,术后1周内及随访时TTE复查手术效果。结果·9例患者均治愈出院。术中TEE证实RPR术后左心室流出道压差(LVOTPG)为(9±3)mm Hg,显著低于RPR术操作前[(92±14)mm Hg](P<0.01),SAM征全部消失。术后1周内TTE显示室间隔厚度、LVOTPG、MR明显好转(P<0.01)。术后平均随访26个月,所有患者症状明显减轻,LVOTPG仍处于较低水平,无明显MR,无死亡,无再次手术及其他并发症。结论·RPR技术可有效解除复杂HOCM的左心室流出道梗阻及MR,提高患者生活质量。

Objective · To evaluate the surgical outcome of RPR composite technique for complex hypertrophic obstructive cardiomyopathy （HOCM）. Methods · From June 2009 to December 2015, 9 complex HOCM patients received RPR procedure. There were 6 males and 3 females with age from 22 to 63 years old and the average age of （43±19） years old. Transthorax echocardiography （TTE） showed systolic anterior motion （SAM） and at least moderate mitral valve regurgitation （MR） in all patients before operations. Transesophageal echocardiography （TEE） was used to evaluate the results of procedures during operation. All the patients had been followed up since one week after operation and examined by TTE. Results · All the patients were discharged without complications. Intraoperative TEE indicated that left ventricular outflow tract pressure gradient （LVOTPG） significantly decreased from （92±14） mmHg before operation to （9±3） mmHg after operation （P〈0.01）. SAM in all the patients disappeared. One week after operation, TTE demonstrated remarkable reduction in the thickness of ventricular septum, LVOTPG and MR than those before operation （P〈0.01）. Mean follow-up was 26 months. All the patients became asymptomatic. LVOTPG remained low and MR remained mild. There were no deaths, reoperations, or any other adverse consequences. Conclusion · RPR technique is an effective surgical method to relieve LVOTO and MR of complex HOCM to lead a better life.