肥厚型梗阻性心肌病中的二尖瓣处理策略及争议  

Mitral valve management in hypertrophic obstructive cardiomyopathy and its controversies

作　　者：李碧兰[1,3] 谢林 李娅姣[2] 何泽栋[1] 钱宏 LI Bilan;XIE Lin;LI Yajiao;HE Zedong;QIAN Hong(Department of Cardiovascular Surgery,West China Hospital,Sichuan University,Chengdu,610041,P.R.China;Department of Cardiology,West China Hospital,Sichuan University,Chengdu,610041,P.R.China;Department of Nursing,West China Hospital,Sichuan University,Chengdu,610041,P.R.China)

机构地区：[1]四川大学华西医院心脏大血管外科,成都610041 [2]四川大学华西医院心脏内科,成都610041 [3]四川大学华西医院四川大学华西护理学院,成都610041

出　　处：《中国胸心血管外科临床杂志》2024年第8期1242-1248,共7页Chinese Journal of Clinical Thoracic and Cardiovascular Surgery

摘　　要：肥厚型梗阻性心肌病(hypertrophic obstructive cardiomyopathy,HOCM)为一种相对常见的遗传性心肌病,以非对称性心肌肥厚及动态性左心室流出道(left ventricular outflow tract,LVOT)梗阻为主要特点。除以室间隔肥厚为主的心肌肥厚外,二尖瓣异常亦在HOCM患者中广泛存在,其亦是收缩期二尖瓣前向运动(systolic anterior motion,SAM)和LVOT梗阻的原因之一。室间隔心肌切除术被认为是HOCM外科矫治的标准术式,但随着对HOCM患者中二尖瓣异常的不断探索,多种针对性的矫治策略被相继提出,但是否应在进行室间隔心肌切除的同时对二尖瓣进行处理尚存在诸多争议与分歧。本文详述了HOCM患者中存在的二尖瓣异常及其对应的外科处理策略;此外,本文亦结合了现有的临床研究结果阐释了目前在HOCM外科矫治中与二尖瓣手术相关的争议。Hypertrophic obstructive cardiomyopathy(HOCM)is a relatively common hereditary cardiomyopathy,which is featured by asymmetric myocardial hypertrophy and dynamic left ventricular outflow tract(LVOT)obstruction.Other than septal hypertrophy,mitral valve abnormalities are also quite common in HOCM patients,and they also contribute to systolic anterior motion of the mitral leaflets and LVOT obstruction.Septal myectomy is believed as the standard surgical treatment for HOCM,but whether to perform mitral valve procedures at the same time of myectomy is still debatable.In this article,we thoroughly explained the mitral valve abnormalities in HOCM patients and their surgical corrections.Besides,we also explained the controversies over mitral valve procedures based on the current clinical studies.

关 键 词：肥厚型梗阻性心肌病 左心室流出道梗阻 二尖瓣异常 综述 

分 类 号：R654.2[医药卫生—外科学]