改良扩大Morrow术治疗肥厚型梗阻性心肌病近中期结果分析

Short-and mid-term outcomes of modified extended Morrow procedure surgical treatment for hypertrophic obstructive cardiomyopathy

目的:总结改良扩大Morrow术治疗肥厚型梗阻性心肌病的临床经验,分析其近中期结果。方法:回顾性分析2012年5月至2019年6月,在我院行改良扩大Morrow术的26例肥厚型梗阻性心肌病患者临床资料。其中女性18例,男性8例,年龄31~67岁,平均年龄(45.6±13.5)岁。所有患者均经主动脉切口行改良扩大Morrow术,合并心脏病变同期处理,比较术前、术后及随访时超声心动图、心电图结果及并发症情况。结果:全组无手术死亡,单纯行改良扩大Morrow术18例,同期冠状动脉旁路移植术1例,二尖瓣成形或置换术5例,主动脉瓣置换术1例,心房颤动改良迷宫术1例。随访3~90个月,左心室流出道压差[(20.3±17.5)vs.(65.2±27.5)mm Hg,1 mm Hg=0.133 k Pa]、最大室间隔厚度[(18.6±6.4)vs.(26.3±5.1)mm]均较术前明显降低,LVEDD[(43.3±4.1)vs.(38.7±4.9)mm]较术前增加,差异均有统计学意义(P<0.05);24例(92.3%)患者NYHA心功能分级Ⅰ或Ⅱ级,较术前明显改善(P<0.01),二尖瓣反流程度减轻(P<0.01),二尖瓣收缩期前向运动现象消失。术后并发症包括:III°房室传导阻滞2例(8.3%);2例患者因切除范围不够致术后残余左心室流出道压差,1例再次行改良扩大Morrow术。结论:肥厚型梗阻性心肌病患者行改良扩大Morrow术可获得良好的近中期效果,不良事件发生率低,远期结果有待进一步随访观察。

Objective:To summarize the clinical experience of modified extended morrow procedure in the treatment of hypertrophic obstructive cardiomyopathy,and analyze the outcomes of the short-and mid term.Methods:We retrospectively analyzed the clinical data of 26 consecutive patients with hypertrophic obstructive cardiomyopathy who underwent modified extended morrow operation in our hospital between May 2012 and June2019.There were 18 females and 8 males with an average age of 31~78(61.5±8.3)years.All patients underwent modified expanded morrow procedure through aortic incision under general anesthesia and hypothermia cardiopulmonary bypass.Other abnormalities were performed concomitantly.The result of transthoracic echocardiography,electrocardiogram and major complications were compared preoperatively,postoperatively and during the follow-up.Results:There was no operative mortality in the group.Eighteen patients underwent modified extended morrow operation,1 coronary artery bypass operation,5 mitral valvuloplasty or replacement,1 aortic valve replacement and 1 atrial fibrillation modified radiofrequency maze operation concomitantly.The mean follow-up period was(25.7±23.5)months(3-90 months),and 2 cases(7.7%)lost contact.The left ventricular outflow tract pressure gradient(20.3±17.5)(1 mm Hg=0.133 k Pa)vs.(65.2±27.5)mm Hg,the maximum interventricular septal thickness(18.6±6.4)vs.(26.3±5.1)mm were significantly lower than preoperative values,and the LVEDD(43.3±4.1)vs.(38.7±4.9)mm were significantly higher than preoperative values(P<0.05).24 patients(92.3%)had NYHA cardiac function grade I or II,which was significantly improved(P<0.01),the degree of mitral regurgitation decreased(P<0.01),and the sign of systolic anterior motion of mitral valve disappeared.The postoperative complications included:Three degree atrioventricular block in 2 cases(8.3%),permanent pacemaker implantation;The left ventricular outflow tract pressure gradient of 2 patients descended slightly because of insufficient resection scope and 1 case underwent modified extended morrow operation again due to residual left ventricular outflow tract pressure gradient.Conclusions:The modified extended morrow procedure in patients with hypertrophic obstructive cardiomyopathy can achieve satisfactory results in short-and mid-term with low incidence of adverse events.The long-term outcomes need further followup observation.