Survival of patients with severe congenital aortic stenosis beyond third decade is uncommon. This report describes a 31 year old patient who underwent successful aortoplasty and in addition septal myectomy for complet...Survival of patients with severe congenital aortic stenosis beyond third decade is uncommon. This report describes a 31 year old patient who underwent successful aortoplasty and in addition septal myectomy for complete relief of left ventricular outflow obstruction.展开更多
Background： Percutaneous transluminal septal myocardial ablation （PTSMA） and modified Morrow septal myectomy （MMSM） are two invasive strategies used to relieve obstruction in patients with hypertrophic cardiomyop...Background： Percutaneous transluminal septal myocardial ablation （PTSMA） and modified Morrow septal myectomy （MMSM） are two invasive strategies used to relieve obstruction in patients with hypertrophic cardiomyopathy （HCM）. This study aimed to determine the clinical outcome of these two strategies. Methods： From January 2011 to January 2015,226 patients with HCM were treated, 68 by PTSMA and 158 by MMSM. Both ultrasonic cardiograms and heart functional class were recorded before, alter operations and in the follow-up. Categorical variables were compared using Chi-square or Fisher＇s exact tests. Quantitative variables were compared using the paired samples t-test. Results： lnterventricular septal thickness was significantly reduced in both groups （21.27 ± 4.43 mm vs. 18.72 ±4.13 mm for PTSMA, t = 3.469, P 〈 0.001, and 21.83± 5.03 mm vs. 16.57 ± 3.95 mm for MMSM, t = 10.349, P 〈 0.001, respectively）. The left ventricular outflow tract （LVOT） pressure gradient （PG） significantly decreased after the operations in two groups （70.30 ± 44.79 mmHg vs. 39.78 ±22.07 mmHg for PTSMA, t = 5.041, P 〈 0.001, and 74.58 ± 45.52 mmHg vs. 13.95 ± 9.94 mmHg for MMSM, t = 16.357, P 〈 0.001, respectively）. Seven patients （10.29%） in the PTSMA group required a repeat operation in the follow-up. Eight （11.76%） patients were evaluated for New York I-lean Association （NYHA） Ill/IV in the PTSMA group, which was significantly more than the five （3.16%） in the same NYHA classes lbr the MMSM group at follow-up. Less than 15% of patients in the PTSMA group and none of the patients in the MMSM group complained of chest pain during follow-up. Conclusions： Both strategies can not only relieve LVOT PG but also improve heart function in patients with HCM. However, MMSM might provide a more reliable reduction in gradients compared to PTSMA.展开更多
Hospital volume is regarded amongst many in the medical community as an important quality metric. This is especially true in more complicated and less commonly performed procedures such as structural heart disease int...Hospital volume is regarded amongst many in the medical community as an important quality metric. This is especially true in more complicated and less commonly performed procedures such as structural heart disease interventions. Seminal work on hospital volume relationships was done by Luft et al more than 4 decades ago, when they demonstrated that hospitals performing > 200 surgical procedures a year had 25%-41% lower mortality than those performing fewer procedures. Numerous volume-outcome studies have since been done for varied surgical procedures. An old adage "practice makes perfect" indicating superior operator and institutional experience at higher volume hospitals is believed to primarily contribute to the volume outcome relationship. Compelling evidence from a slew of recent publications has also highlighted the role of hospital volume in predicting superior post-procedural outcomes following structural heart disease interventions. These included transcatheter aortic valve repair, transcatheter mitral valve repair, septal ablation and septal myectomy for hypertrophic obstructive cardiomyopathy, left atrial appendage closure and atrial septal defect/patent foramen ovale closure. This is especially important since these structural heart interventions are relatively complex with evolving technology and a steep learning curve. The benefit was demonstrated both in lower mortality and complications as well as better economics in terms of lower length of stay and hospitalization costs seen at high volume centers. We present an overview of the available literature that underscores the importance of hospital volume in complex structural heart disease interventions.展开更多
文摘Survival of patients with severe congenital aortic stenosis beyond third decade is uncommon. This report describes a 31 year old patient who underwent successful aortoplasty and in addition septal myectomy for complete relief of left ventricular outflow obstruction.
基金This work was supported by grants from the National Natural Science Foundation of China （No. 81370328, and No. 81770371）.
文摘Background： Percutaneous transluminal septal myocardial ablation （PTSMA） and modified Morrow septal myectomy （MMSM） are two invasive strategies used to relieve obstruction in patients with hypertrophic cardiomyopathy （HCM）. This study aimed to determine the clinical outcome of these two strategies. Methods： From January 2011 to January 2015,226 patients with HCM were treated, 68 by PTSMA and 158 by MMSM. Both ultrasonic cardiograms and heart functional class were recorded before, alter operations and in the follow-up. Categorical variables were compared using Chi-square or Fisher＇s exact tests. Quantitative variables were compared using the paired samples t-test. Results： lnterventricular septal thickness was significantly reduced in both groups （21.27 ± 4.43 mm vs. 18.72 ±4.13 mm for PTSMA, t = 3.469, P 〈 0.001, and 21.83± 5.03 mm vs. 16.57 ± 3.95 mm for MMSM, t = 10.349, P 〈 0.001, respectively）. The left ventricular outflow tract （LVOT） pressure gradient （PG） significantly decreased after the operations in two groups （70.30 ± 44.79 mmHg vs. 39.78 ±22.07 mmHg for PTSMA, t = 5.041, P 〈 0.001, and 74.58 ± 45.52 mmHg vs. 13.95 ± 9.94 mmHg for MMSM, t = 16.357, P 〈 0.001, respectively）. Seven patients （10.29%） in the PTSMA group required a repeat operation in the follow-up. Eight （11.76%） patients were evaluated for New York I-lean Association （NYHA） Ill/IV in the PTSMA group, which was significantly more than the five （3.16%） in the same NYHA classes lbr the MMSM group at follow-up. Less than 15% of patients in the PTSMA group and none of the patients in the MMSM group complained of chest pain during follow-up. Conclusions： Both strategies can not only relieve LVOT PG but also improve heart function in patients with HCM. However, MMSM might provide a more reliable reduction in gradients compared to PTSMA.
文摘Hospital volume is regarded amongst many in the medical community as an important quality metric. This is especially true in more complicated and less commonly performed procedures such as structural heart disease interventions. Seminal work on hospital volume relationships was done by Luft et al more than 4 decades ago, when they demonstrated that hospitals performing > 200 surgical procedures a year had 25%-41% lower mortality than those performing fewer procedures. Numerous volume-outcome studies have since been done for varied surgical procedures. An old adage "practice makes perfect" indicating superior operator and institutional experience at higher volume hospitals is believed to primarily contribute to the volume outcome relationship. Compelling evidence from a slew of recent publications has also highlighted the role of hospital volume in predicting superior post-procedural outcomes following structural heart disease interventions. These included transcatheter aortic valve repair, transcatheter mitral valve repair, septal ablation and septal myectomy for hypertrophic obstructive cardiomyopathy, left atrial appendage closure and atrial septal defect/patent foramen ovale closure. This is especially important since these structural heart interventions are relatively complex with evolving technology and a steep learning curve. The benefit was demonstrated both in lower mortality and complications as well as better economics in terms of lower length of stay and hospitalization costs seen at high volume centers. We present an overview of the available literature that underscores the importance of hospital volume in complex structural heart disease interventions.
