梗阻性肥厚型心肌病的外科治疗  

Surgical treatment of obstructive hypertrophic cardiomyopathy with ventricular septal myectomy concomitant mitral valve replacement

作　　者：王睿[1] 陈鑫[1] 徐明[1] 石开虎[1] 汪黎明[1] 肖立琼[1] 刘培生[1] 

机构地区：[1]南京医科大学附属南京第一医院南京市心血管病医院,210006

出　　处：《中华外科杂志》2008年第20期1572-1574,共3页Chinese Journal of Surgery

摘　　要：目的总结肥厚室间隔切除联合二尖瓣置换术治疗梗阻性肥厚型心肌病的手术效果和经验体会。方法2000年1月至2007年6月，共对22例合并有中度以上二尖瓣反流的OHCM患者实施肥厚室间隔切除联合二尖瓣置换术。其中男性20例，女性2例；年龄28—51岁，平均（36±5）岁。左心室流出道压差55～120mmHg（1mmHg=0．133kPa），平均（88．0±15．8）mmHg。分析比较患者术前超声心动图，术中经食管心脏超声，以及术后10d、6个月、1年超声心动图的结果。结果术后因顽固性室性心律失常死亡1例。术中经食管超声示所有患者二尖瓣前叶收缩期前向运动现象消失。存活的21例患者均获随访，术后各时间点左心室流出道压差和室间隔厚度均较术前下降（P〈0．01）。结论肥厚室间隔切除联合二尖瓣置换术治疗合并中度以上二尖瓣反流的梗阻性肥厚型心肌病，近中期手术效果可靠，并发症少。Objective To summarize the experiences and results of ventrcular septal myectomy concomitant mitral valve replacement （MVR） for obstructive hypertrophic cardiomyopathy （OHCM）. Methods From January 2000 to June 2007, 22 patients of OHCM with moderate or severe mitral regurgitation underwent concomitant ventricular septal myeetomy concomitant MVR. There were 20 male and 2 female patients. The age ranged from 28 to 51 years old with a mean of （ 36 ±5 ） years old. The left ventrieular out tract gradient pressure （LVOTGP） was 55 to 120 mm Hg （1 mm Hg =0. 133 kPa）, with a mean of （ 88.0 ±15.8） mm Hg. The manifestation of pre-operative UCG, intro-operative transesophageal eehocardiography （TEE） and post-operative UCG in 10 d, 6 months and 1 year were compared and analyzed. Results One patient died in hospital due to serious ventrieular arrhythmias. The intro-operative TEE showed that the phenomenon of systolic anterior motion （SAM） of mitral valve disappeared in all patients. Twenty-one eases were followed-up. The intro-operative TEE and post-operative UCG in every period of all 21 cases survived indicated that the mean LVOTGP and interventricular septal thickness （IVST） decreased obviously （P 〈 0. 01 ）. Conclusion Concomitant ventricular septal myectomy concomitant MVR is an effective and safe treatment for OHCM with moderate or severe mitral regurgitation, the short and midterm outcome is excellent.

关 键 词：心肌病 肥厚性 心脏外科手术 治疗效果 

分 类 号：R686[医药卫生—骨科学]