经主动脉联合心尖切口室间隔心肌切除术治疗复杂性肥厚型梗阻性心肌病的早期效果  

Early outcomes of combined transaortic and transapical approach to septal myectomy in patients with complex hypertrophic obstructive cardiomyopathy

作　　者：聂长荣 朱昌盛[1] 肖明虎[2] 蒙延海[3] 杨秋蓝[3] 王水云[1] Nie Changrong;Zhu Changsheng;Xiao Minghu;Meng Yanhai;Yang Qiulan;Wang Shuiyun(Department of Cardiovascular Surgery,Fuwai Hospital,National Center for Cardiovascular Diseases,Chinese Academy of Medical Sciences and Peking Union Medical College,Beijing 100037,China;Department of Ultrasound,Fuwai Hospital,National Center for Cardiovascular Diseases,Chinese Academy of Medical Sciences and Peking Union Medical College,Beijing 100037,China;Department of intensive care unit,Fuwai Hospital,National Center for Cardiovascular Diseases,Chinese Academy of Medical Sciences and 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,阜外医院成人外科中心七病区,100037 [2]中国医学科学院,北京协和医学院,国家心血管病中心,阜外医院超声科,100037 [3]中国医学科学院,北京协和医学院,国家心血管病中心,阜外医院重症监护室,100037

出　　处：《中华胸心血管外科杂志》2021年第12期733-736,共4页Chinese Journal of Thoracic and Cardiovascular Surgery

基　　金：首都卫生发展科研专项(首发2020-2-4036)。

摘　　要：目的评价经主动脉联合心尖切口心肌切除术治疗复杂性肥厚型梗阻性心肌病(HOCM)的早期手术效果。方法回顾性分析2019年1月至2019年10月在阜外医院接受手术的357例HOCM患者资料,其中接受经主动脉联合心尖切口心肌切除术治疗的复杂性HOCM共20例。将此20例患者纳入研究并评价经主动脉联合心尖切口心肌切除术治疗复杂性HOCM的早期治疗效果。手术前、后超声心动图检查比较左心房前后径、左心室舒张末期内径、室间隔厚度、左心室流出道压差或左心室中部压差、二尖瓣前叶收缩期前向运动(SAM征)以及二尖瓣反流情况;手术前、后心电图分析心电变化;手术前、后纽约心脏病协会(NYHA)心功能分级评价心功能改变。结果左心室流出道梗阻且肥厚累及主动脉瓣下7 cm以上7例(35%),左心室流出道合并左心室中部梗阻4例(25%),心尖肥厚或闭塞5例(25%),合并心尖室壁瘤4例(25%)。与术前相比,术后患者的室间隔厚度减少[(21.1±3.6)mm对(13.4±3.1)mm];左心室流出道压差或左心室中部压差显著降低[(77.0±21.0)mmHg(1 mmHg=0.133 kPa)对(9.2±3.4)mmHg]或[(71.0±23.0)mmHg对0 mmHg];二尖瓣反流较术前明显减轻,降至少量及以下[(1.9±1.5)对(0.2±0.4)];SAM征消失;心功能(NYHA分级)明显改善[(2.1±0.2)级对(1.3±0.5)级];术后左束支传导阻滞增加[0对9(45%)],1例(5%)安装永久性起搏器,无其他严重并发症。术后30天生存率100%。结论经主动脉联合心尖切口室间隔心肌切除术是治疗复杂性HOCM安全且有效的手术术式.Objective To evaluate the early effects of combined transaortic and transapical approach to septal myectomy in patients with complex hypertrophic obstructive cardiomyopathy(HOCM).Methods We consecutively enrolled 20 complex HOCM patients who received transaortic and transapical myectomy in fuwai hospital from January 2019 to October 2019.Echocardiography was performed to compare left atrial size,left ventricular end diastolic diameter,peak left ventricular outflow gradient,ventricular septal thickness,mitral systolic anterior motion and mitral regurgitation grade before and after operation.Furthermore,pre-operative and post-operative electrocardiogram were also analyzed to determine the incidence of bundle branch block.Functional status was evaluated by New York Heart Association functional class.Results Of the 20 complex hypertrophic cardiomyopathy patients,7(35%)HOCM patients with long-segment septal hypertrophy more than 7cm,4(20%)patients had both mid-ventricular obstruction and left ventricular outflow obstruction.Apical hypertrophic cardiomyopathy with LOVT obstruction was observed in 5 patients(25%)and aneurysm was found in 4(20%)HOCM patients.Postoperative thickness of ventricular septum was significantly decreased compared with that of preoperation[(21.1±3.6)mm vs.(13.4±3.1)mm].Peak LOVT gradient or mid-ventricular gradient also significantly reduced after operation[(77.0±21.0)mmHg vs.(9.2±3.4)mmHg]or[(71.0±23.0)mmHg vs.0 mmHg,1 mmHg=0.133 kPa];After surgery,mitral systolic anterior motion disappeared,mitral regurgitation degree reduced from(1.9±1.5)to(0.2±0.4);NYHA class improved from(2.1±0.2)to(1.3±0.5).New incidence of left bundle branch block occurred in 9 patients,and 1 patient developed complete bundle branch block and implanted permanent pacemaker.The 30-day survival was 100%.Conclusion Combined transaortic and transapical septal myectomy is an effective and reasonably safe procedure for patients with complex hypertrophic obstructive cardiomyopathy.

关 键 词：心肌病 肥厚型 主动脉切口 心尖切口 早期效果 

分 类 号：R654.2[医药卫生—外科学]