改良Morrow术治疗经皮室间隔消融术后的肥厚型梗阻性心肌病  

Surgical Treatment with Modified Morrow Procedure in Hypertrophic Obstructive Cardiomyopathy after Percutaneous Transluminal Septal Myocardial Ablation

作　　者：然鋆[1] 宋云虎[1] 胡盛寿[1] 王水云[1] 孙寒松[1] 

机构地区：[1]中国医学科学院北京协和医学院国家心血管病中心阜外医院国家心血管病临床研究中心阜外医院心脏外科,北京市100037

出　　处：《中国分子心脏病学杂志》2017年第2期2009-2011,共3页Molecular Cardiology of China

摘　　要：目的研究经皮室间隔消融术后的肥厚型梗阻性心肌病行改良Morrow术的安全性和有效性。方法我们回顾性研究了2002年12月至2015年9月我院外科手术治疗的27例经皮室间隔消融术(PTSMA)后的肥厚型梗阻性心肌病行改良Morrow术的病例。其中男性17例(63%)、年龄49±8(32-62)岁、所有病例均在接受了药物治疗和PTSMA后仍有临床症状且术前左心室流出道压差达98±30mm Hg(50-159mm Hg)。术式包括了单纯改良Morrow术17例(63%),9例合并冠状动脉旁路移植术以及1例合并房颤射频消融术。结果术后远期随访共19(13-38)月,随访率93%。全组病例近远期总死亡率为3.7%(n=1)。术后远期随访78%的患者无明显临床症状,其1年及5年生存率分别为96%和96%。术后共有2例完全房室传导阻滞和7例完全性左束支传导阻滞产生。超声提示绝大部分病例的左室流出道压差接近正常。术后心功能NYHA分级为Ⅰ级者占93%。结论改良Morrow术可以安全的解除曾行经皮室间隔消融术后的肥厚型梗阻性心肌病患者的左心室流出道梗阻,明确地缓解患者临床症状,且具有较好的近远期生存率。Objective To evaluate the efficacy and safety of modified Morrow procedure in hypertrophic obstructive cardiomyopathy （HOCM） after Percutaneous transluminal septal myocardial ablation（PTSMA）. Methods We retrospectively examined 27 consecutive patients with HOCM after PTSMA operated in our institution from 2002-12 to 2015-9. Male 17 cases（63%）, age 49±8（32-62）years, all the patients had drug-refractory symptoms even after PTSMA and a left ventricular outflow tract（LVOT） gradient of 98±30mmHg（50-159mmHg） by doppler echocardiography. 17 patients （63%） underwent isolated septal myectomy and others combined with coronary artery bypass grafting or atrial fibrillation ablation. Results The mean follow-up time was 19（13-38）month, Follow-up rate is 93%. The overall mortality rate was 3.7% （n=1）.The late symptom-free rate was 78%.The cumulative survival rate at 1 year, and 5 years was 96% and 96% respectively. Complete atrioventricular block occurred in 2 patients and complete left bundle branch block occurred in 7 patients.The LVOT gradient was eliminated in most patients, 93% of the patient has a New York Heart Association functional class I. Conclusions Modified Morrow procedure can be performed safely in patients with HOCM after PTSMA which can eliminate LVOT obstruction and relief symptoms with excellent survival rate.The early benefits were remained at long term.

关 键 词：肥厚梗阻型心肌病 改良Morrow手术 室间隔心肌切除术 经皮室间隔消融术 外科治疗 

分 类 号：R654.2[医药卫生—外科学]