室间隔减容术后肥厚型梗阻性心肌病患者再次行室间隔心肌切除术的疗效分析  

Efficiency for Reoperation in Patients with Obstructive Hypertrophic Cardiomyopathy after Septal Reduction Therapy

作　　者：张杨[1] 朱昌盛[2] 宋昌鹏 张健[1] 郑欣馨[1] 鲁洁[1] 房晓楠[1] 王水云[2] 黄晓红[1] ZHANG Yang;ZHU Chang-sheng;SONG Chang-peng;ZHANG Jian;ZHENG Xin-xin;LU Jie;FANG Xiao-nan;WANG Shui-yun;HUANG Xiao-hong(Department of Special Medical Treatment Center,State Key Laboratory of Cardiovascular Disease,Fuwai Hospital,National Center for Cardiovascular Diseases,Chinese Academy of Medical Sciences&Peking Union Medical College,Beijing 100037,China;Department of Cardiovascular Surgery,State Key Laboratory of Cardiovascular Disease,Fuwai Hospital,National Center for Cardiovascular Diseases,Chinese Academy of Medical Sciences&Peking Union Medical College,Beijing 100037,China)

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心血管疾病国家重点实验室特需医疗中心,北京市100037 [2]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心血管疾病国家重点实验室心脏外科,北京市100037

出　　处：《中国分子心脏病学杂志》2021年第2期3845-3849,共5页Molecular Cardiology of China

基　　金：国家重点研发计划(2016YFC1300901);首都卫生发展科研专项基金(首发2020-2-4036);中国医学科学院中央级公益性科研院所基本科研业务费临床与转化医学研究基金(2019XK320054)。

摘　　要：目的分析室间隔减容手术(SRT)后的肥厚型梗阻性心肌病(OHCM)患者再次接受室间隔心肌切除术的临床特征及手术疗效。方法回顾性分析2014年1月至2019年12月期间在阜外医院接受再次SRT手术的OHCM患者的临床特征,并结合术前、术后及随访情况评估手术疗效。根据患者首次进行SRT的手术方式,将所有患者分为室间隔心肌切除术(SM)组和室间隔酒精消融术(ASA)组。结果31例患者纳入研究,男性21例,平均年龄为48.7±12.2岁,SM组和ASA组分别有7例及24例患者。全部患者入院后均接受SM手术,其中18例(58.1%)行单纯SM手术,其余13例患者合并其他手术,术式包括二尖瓣手术(1例)、三尖瓣成形术(1例)、冠状动脉心肌桥松解术(1例)、迷宫手术(5例)。术前心电图显示,SM组有4例患者合并完全性左束支传导阻滞,ASA组有7例患者合并完全性右束支传导阻滞。术后有4例患者因完全性房室传导阻滞植入永久起搏器,其中3例患者为ASA组且合并完全性右束支传导阻滞。围术期术后除1名患者出现电风暴而死亡外,其余患者未见严重并发症。与术前相比,术后左室流出道与主动脉峰值压力阶差降低[(64.0±37.4)mm Hg vs.(10.2±8.9)mm Hg,P<0.001],室间隔厚度减低[(17.8±3.9)mm vs.(12.7±2.1)mm,P<0.001]。术后患者二尖瓣中重度反流明显减轻(P<0.001),二尖瓣收缩期前向运动现象消失。术后随访23.5±10.9个月,无远期死亡或再次手术治疗事件。随访超声心动图结果显示,除2名患者再次出现流出道梗阻外,其余患者的左心房内径、室间隔厚度和左室流出道与主动脉峰值压力阶差均较术前明显降低。结论SRT术后OHCM患者症状复发,再次行室间隔心肌切除术是安全有效的。需要注意术前是否存在室内传导阻滞,以评估术后发生完全性房室传导阻滞需要永久起搏器治疗的风险。Objective To analyze the clinical characteristics and surgical outcomes of patients with obstructive hypertrophic cardiomyopathy(OHCM)undergoing repeated septal reduction therapy(SRT).Methods The clinical characteristics of OHCM patients who received repeated SRT from January 2014 to December 2019 in Fuwai Hospital were retrospectively analyzed.The clinical data,pre-operation conditions,postoperation conditions,and follow-up data were analyzed to evaluate the surgical outcomes.Patients were divided into septal myectomy(SM)group and alcohol septal ablation(ASA)group according to the primary procedure of SRT.Results A total of 31 patients(21 males)were included in the study.The average age was(48.7±12.2)years.There were 7 patients in the SM group and 24 patients in the ASA group.All patients had performed SM,of which 18 patients(58.1%)undergoing SM surgery alone.The remaining 13 patients were performed on other procedures in the same period,such as mitral valve procedures in 6 patients,tricuspid valve angioplasty in 1 patient,myocardial unroofing in 1 patient,maze operation in 5 patients.Preoperative electrocardiogram showed that 4 patients in the SM group presented with complete left bundle branch block,and 7 patients in the ASA group presented with complete right bundle branch block.After the operation,4 patients were implanted with permanent pacemakers due to complete atrioventricular block,of which 3 patients were in the ASA group with complete right bundle branch block.During the perioperative period,except for one death caused by electrical storm,the remaining patients had no serious complications.Compared with preoperatively data,the post-echocardiography showed a significant reduction in left ventricular outflow tract gradient[(64.0±37.4)mm Hg vs.(10.2±8.9)mm Hg,P<0.001],and the thickness of interventricular septum[(17.8±3.9)mm vs.(12.7±2.1)mm,P<0.001].The moderate or severe mitral valve regurgitation was significantly reduced after the operation(P<0.001),and the systolic anterior motion disappeared.Du

关 键 词：肥厚型梗阻性心肌病 室间隔减容术 再次手术 室间隔心肌切除术 

分 类 号：R654.2[医药卫生—外科学]