行改良扩大Morrow手术治疗肥厚型梗阻性心肌病168例近中期结果  

The Early Mid-term Outcomes of Modified Morrow Procedure for Treating 168 Patients With Hypertrophic Obstructive Cardiomyopathy

作　　者：宋云虎[1] 李浩杰[1] 高歌[1] 苏文君[1] 然鋆[1] 张昌伟[1] 樊红光[1] 

机构地区：[1]中国医学科学院北京协和医学院心血管病研究所阜外心血管病医院成人心脏外科,北京市100037

出　　处：《中国循环杂志》2014年第5期377-381,共5页Chinese Circulation Journal

摘　　要：目的:分析改良扩大Morrow术治疗肥厚型梗阻性心肌病(HOCM)的近中期疗效。方法:回顾性分析作者本人在单中心应用改良扩大Morrow术连续治疗168例HOCM患者的手术早期结果,并通过随访,评估手术的近中期疗效。结果:全组患者无手术死亡。左心室流出道(LVOT)压差从(92.4±30.8)mmHg(1 mmHg=0.33 kPa)下降至(16.1±10.1)mmHg(P<0.001),二尖瓣反流明显改善(P<0.001)。术后3例(1.8%)患者因完全性房室传导阻滞安装永久起搏器,3例(1.8%)患者并发室间隔穿孔术中同期修补,1例患者近心尖部前侧壁穿孔同期修补,新发持续性心房颤动2例。随访107例,平均随访时间(15±11)个月,LVOT压差为(14.2±12.7)mmHg。随访期间,80例患者无症状,从事日常家务劳动或恢复工作,NYHA心功能分级较术前明显改善(P<0.001)。HOCM相关事件发生率7.5%,包括4例心房颤动、2例心肌缺血、1例心力衰竭及1例脑卒中合并心力衰竭患者再次住院治疗。1例患者于术后57个月因stanford A型夹层破裂死亡。结论:经升主动脉切口行改良扩大Morrow手术治疗HOCM疗效确切。Objective： To analyze the early mid-term outcomes of modified Morrow procedure in patients with hypertrophic obstructive cardiomyopathy （HOCM）. Methods： A total of 168 consecutive HOCM patients who received modified Morrow procedure in our hospital were retrospectively summarized. The clinical effect with the early mid-term outcomes were followed-up. Results： No patient died during the operation. After the operation, the left ventricular outflow tract （LVOT） pressure gradient decreased from （92.4±30.8） mmHg to （16.1±10.1） mmHg and the mitral regurgitation was significantly improved, all P〈0.001. There were 3/168 （1.8%） patients received permanent pacemaker implantation because of complete atrial-ventricular block, 3 received simultaneous ventricular septal perforation repairing, 1 received apical anterior wall perforation repairing, and 2 patients suffered from persistent atrial fibrillation （AF）. There were107 patients finished the follow-up study for （15±11） months. During that period, the average LVOT pressure gradient was at （14.2±12.7） mmHg, there were 80 patients without symptoms who engaged in daily house activity or returned to work. The post-operative NYHA significantly improved than pre-operation, P〈0.001. HOCM related events were at 7.5% including 4 patients ofAF, 2 myocardial ischemia, 1 heart failure （HF）, 1 stoke accompanying HF with rehospitalization.1 patient died by Stanford type A aortic dissection rupture at 57 months after the operation. Conclusion： Modified Morrow procedure across the aortic incision was an effective treatment for HOCM patients.

关 键 词：肥厚型心肌病 梗阻 改良扩大Morrow术 左心室流出道 随访 

分 类 号：R54[医药卫生—心血管疾病]