外科治疗肥厚型梗阻性心肌病的疗效评价  

The evaluation of surgical treatment for hypertrophic obstructive cardiomyopathy

作　　者：杨建国[1] 陈绪发[1] 何亚峰[1] 陶凉[1] 

机构地区：[1]武汉亚洲心脏病医院心外科,湖北430022

出　　处：《心肺血管病杂志》2015年第6期461-464,共4页Journal of Cardiovascular and Pulmonary Diseases

摘　　要：目的：探讨肥厚型梗阻性心肌病（HOCM）的外科手术疗效.方法：回顾性分析2010年6月至2013年12月,我院外科行改良扩大Morrow手术治疗65例HOCM患者的临床资料,其中男性40例（61.5％）,年龄18～ 70岁,平均（48.4±11.5）岁,术前所有患者药物治疗后临床症状仍明显,术前左心室流出道压差（LVOTG）为62 ～ 140mmng（1mmHg =0.133kPa）,平均（85.5±28.6） mmmHg,65例患者均有收缩期前向运动（SAM征）.全部患者均接受室间隔心肌切除术（改良扩大的MORROW手术）,其中8例（12.3％）合并心脏瓣膜手术,1例（1.53％）合并冠状动脉旁路移植术.术后观察手术疗效.结果：全组无住院死亡,手术无瓣叶损伤及室间隔穿孔发生.手术后左心室流出道压差（LVOTG）、室间隔厚度（IVS）、左心室射血分数（LVEF）、左心室舒张末期内径（LYEDD）以及二尖瓣反流（MI）程度较术前均降低,差异有统计学意义（P＜O.05）.术后3例发生完全房室传导阻滞,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％）患者的临床症状消失,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的梗阻,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 surgical procedures and clinical results of surgical treatment in pa- tients with hypertrophic Obstructive eardiomyopathy. Methods：We retrospectively examined 65 consecutive pa- tients with Hypertrophic obstructive eardiomyopathy operated in our institution from 2010 June to 2013 Decem- ber. Male 40 cases（61.5% ）, age 18 -70 （48.4 ± 11.5） years, all the patients had drug-refractory symptoms and a left ventrieular outflow tract of gradient 62 - 145 （ 85.5 ± 28. 6 ） mmHg by Doppler echocardiography. All patients had the systolic anterior movement of the mitral leaflet. （ SAM ）. All patients underwent septal myectomy （modified MORROW procedure）and 8 patients （ 12. 3 % ） combined valvular surgery, 1 patient （ 1.53% ） com- bined coronary artery bypass grafting. Postoperative clinical effect were observed. Results：There was no in-hos- pital death . No valve was injuried and no patient had ventricular septal perforation. Postoperative LVOT gradi- ent, Interventrieular septum （ IVS ）, Left ventricular end-diastolic （ LVEDD ） , Left ventricular ejection fraction （LVEF） and Mitral regurgitation（MR） were significantly lower than preoperative values （ P 〈 O. 05 ） . Complete atrioventrieular block occurred in 3 patients, complete left bundle branch block occurred in 7 patients,left ante- rior division block in 3 patients. The follow-up time were 6 ~ 35 monthes. During the follow-up time, the clinical of symptoms of 55 patients were diminished and other patients＇ symptoms were ameliorated significantly. All the patients had a NewYork Heart Association functional class I/II during the follow-up. Conclusion： Surgical sep- tal myeetomy can eliminate left ventrieular outflow tract obstructive and relief symptoms obviously. The early and mid-term outcomes were satisfactory.

关 键 词：肥厚型梗阻性心肌病 改良扩大Morrow手术 室间隔心肌切除术 

分 类 号：R54[医药卫生—心血管疾病]