肥厚型梗阻性心肌病合并冠状动脉病变的外科处理  

Surgical management of hypertrophic obstructive cardiomyopathy complicated with coronary heart disease

作　　者：于建波[1] 王生伟 来永强[1] YU Jianbo;WANG Shengwei;LAI Yongqiang(Department of Cardiac Surgery,Bejing Anzhen Hospital affiliated to Capital Medical University,Bejing Institute of Heart,Lung and Blood Vessel Diseases,Beijing 100029,China)

机构地区：[1]首都医科大学附属北京安贞医院心脏外科中心-北京市心肺血管疾病研究所心外科,100029

出　　处：《心肺血管病杂志》2021年第7期707-710,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)合并冠状动脉病变患者的外科处理方法。方法:回顾性分析2014年至2020年在我科行外科手术的HOCM合并冠状动脉病变患者30例,分析患者手术方法及围术期资料,评价手术效果。结果:在30例HOCM患者中,11例患者合并存在冠状动脉肌桥(MB),另有19例存在冠心病需行外科处理;所有患者均于全麻低温体外循环下行改良Morrow术,同期行心肌桥松解术(Unroofing)5例,另有6例肌桥患者行冠状动脉旁路移植术(CABG),其中应用左乳内动脉1例,大隐静脉5例;合并冠心病患者均同期行CABG术,其中10例采用左乳内动脉-左前降支旁路移植加大隐静脉旁路移植,余9例单纯应用大隐静脉进行旁路移植。术后1例患者死于多器官功能衰竭,余患者均康复出院,且术后3个月随访无心绞痛发作。结论:冠状动脉病变在HOCM中相对常见,同期进行CABG术或冠状动脉肌桥松解术是安全有效的;此外,对于合并冠状动脉肌桥患者应优先行肌桥松解术,而松解困难或风险较高者可采取CABG治疗,首选大隐静脉作为桥血管材料。Objective:To explore the surgical treatment of hypertrophic obstructive cardiomyopathy(HOCM)with coronary artery disease.Methods:30 patients with HOCM complicated with coronary artery disease who underwent surgery in our department from 2014 to 2020 were retrospectively analyzed.The surgical method and perioperative data were analyzed to evaluate the surgical effect.Results:Among the 30 patients with HOCM,11 patients had coronary artery muscle bridge(MB),and 19 patients had coronary heart disease and needed surgical treatment;all patients underwent modified morrow operation under general anesthesia and hypothermic cardiopulmonary bypass,and underwent unroofing at the same time.Coronary artery bypass grafting(CABG)was performed in 5 patients and 6 patients,including 1 case of left internal mammary artery and 5 cases of great saphenous vein;CABG was performed in all patients with coronary heart disease,including 10 cases of left internal mammary artery left anterior descending artery and great saphenous vein,and the remaining 9 cases of great saphenous vein.One patient died of multiple organ failure after operation,and the other patients recovered and discharged from the hospital.No angina pectoris occurred during the follow-up of 3 months after operation.Conclusions:Coronary artery disease is relatively common in HOCM,and coronary artery bypass grafting or coronary artery muscle bridge lysis at the same time is safe and effective;in addition,for patients with coronary artery muscle bridge,muscle bridge lysis should be given priority,and CABG can be used for patients with difficult or high risk of coronary artery muscle bridge lysis,and great saphenous vein is the first choice.

关 键 词：肥厚性梗阻性心肌病 改良Morrow手术 冠状动脉肌桥 冠状动脉旁路移植术 

分 类 号：R54[医药卫生—心血管疾病]