室间隔心肌切除术治疗肥厚型梗阻性心肌病的早期结果(附27例疗效分析)

Clinical characteristics of 27 patients with hypertrophic obstructive cardiomyopathy and outcomes after septal myectomy

目的总结肥厚型梗阻性心肌病病人的临床特征,分析室间隔心肌切除术疗效。方法2018年6月~2021年7月本中心就诊的肥厚型梗阻性心肌病病人27例,行单纯室间隔心肌切除术24例。有17例病人术前存在二尖瓣中度以上反流,其中2例同期完成二尖瓣成形,1例同期完成二尖瓣置换,总结临床特征及手术方式,分析室间隔心肌切除术的近期效果。结果术后14例病人恢复至无或轻度反流。左室流出道峰值压差由术前(65.9±47.5)mmHg下降至术后(13.8±10.2)mmHg,室间隔厚度由(22.2±7.3)mm下降至术后(15.9±6.3)mm,差异均有统计学意义。病人症状改善明显,25例病人术后恢复至纽约心脏协会心功能分级Ⅰ~Ⅱ级。未出现术后新发传导阻滞和室间隔穿孔等并发症,无围手术期死亡。结论室间隔心肌切除术可以缓解或根治肥厚型梗阻性心肌病。术前及术中需仔细评估二尖瓣及瓣下结构,多数术前伴发的二尖瓣反流可随左室流出道疏通而得到缓解,无器质性病变的二尖瓣反流多无需成形或置换。

Objective To summarize the clinical characteristics of patients diagnosed with hypertrophic obstructive cardiomyopathy and analyze the therapeutic outcomes after septal myectomy in our center.Methods From June 2018 to July 2021,there were 27 patients diagnosed with hypertrophic obstructive cardiomyopathy received septal myectomy in our center.Their demographic data,clinical characteristics,received surgical techniques,and therapeutic outcomes were retrospectively analyzed.Results 14 patients recovered to no or mild mitral regurgitation after operation.Peak pressure gradient of left ventricle outflow tract was decreased from preoperative(65.9±47.5)mmHg to postoperative(13.8±10.2)mmHg,and the thickness of interventricular septum was decreased from preoperative(22.2±7.3)mm to postoperative(15.9±6.3)mm.The symptoms were improved after operation,with 25 patients recovered to classⅠorⅡheart failure of New York Hear Association.There were no conduction block,ventricular septal perforation or perioperative death occurred among these patients.Conclusion Septal myectomy remains the gold standard for the treatment of hypertrophic obstructive cardiomyopathy.The mitral valve apparatus should be carefully inspected before and during operation.Most mitral regurgitation would recover upon thorough septal myectomy.Mitral valvuloplasty or mitral valve replacement would frequently unnecessary for mitral valve without intrinsic diseases.