外科治疗肥厚型梗阻性心肌病的近中期疗效评价

Short- and Mid-term Effect of Surgical Treatment for Hypertrophic Obstructive Cardiomyopathy

目的探讨肥厚型梗阻性心肌病(HOCM)的外科治疗以及手术近中期疗效。方法回顾性分析2010年6月至2013年12月于武汉亚洲心脏病医院心外科行改良扩大Morrow手术治疗65例HOCM患者的临床资料,其中男40例、女25例,年龄18~70(48.4±11.5)岁。结果全组无住院死亡,手术无瓣叶损伤及室间隔穿孔发生。手术后LVOTG、室间隔厚度(IVS)、左心室射血分数(LVEF)、左心室舒张期末内径(LVEDD)以及二尖瓣反流(MI)程度均较术前降低,差异有统计学意义(P<0.05)。术后发生完全性房室传导阻滞3例,完全性左束支传导阻滞7例,左前分支传导阻滞3例。术后所有患者均随访,随访时间6~35个月,55例(84.6%)患者临床症状消失,其余10例患者症状较术前明显减轻。随访期患者纽约心功能分级(NYHA)为Ⅰ~Ⅱ级。结论室间隔心肌切除术可以解除左心室流出道梗阻,消除或明显改善患者临床症状,具有满意的近中期疗效。

Objective To analyze the surgical procedures and clinical effects of surgical treatment for patients with hypertrophic obstructive cardiomyopathy(HOCM).Methods We retrospectively analyzed the clinical data of sixty-five consecutive patients with HOCM who underwent modified Morrow procedure in Wuhan Asia Heart Hospital between June 2010 and December 2013.There were 40 males and 25 females with mean age of 48.4±11.5 years(ranged18-70 years).Results There was no in-hospital mortality.There was no valve injury or ventricular septal perforation occurred during operation.Postoperative LVOT gradient,interventricular septum(IVS),left ventricular end-diastolic diameter(LVEDD),left ventricular ejection fraction(LVEF) and mitral regurgitation(MR) were significantly lower than preoperative values(P<0.05).Complete atrioventricular block occurred in 3 patients,complete left bundle branch block occurred in 7 patients,and left anterior division block occurred in 3 patients.All patients were followed up for 6-35 months.During the following-up time,the clinical symptoms diminished in 55 patients and ameliorated significantly in other 10 patients.All patients had a NewYork Heart Association functional class Ⅰ/Ⅱ during the follow-up.Conclusion Surgical septal myectomy can eliminate obstruction of left ventricular outflow tract and relief symptoms obviously.The early and mid-term outcomes are satisfactory.