SEPTAL MYECTOMY WITH SUBVALVULAR APPARATUS INTERVENTION IN PATIENTS WITH HYPERTROPHIC OBSTRUCTIVE CARDIOMYOPATHY: IMMEDIATE RESULTS

A. Afanasyev, A. Bogachev-Prokophiev, S. Zheleznev, R. Sharifulin, A. Zalesov, D. Kozmin, A. Karaskov
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Abstract

Aim. Surgical septal myectomy is a standard treatment option for patients with hypertrophic obstructive cardiomyopathy. Subvalvular abnormalities of the mitral valve may play an important role in residual left ventricular outflow tract obstruction. This study aimed to evaluate the surgical outcomes of septal myectomy with subvalvular interventions.Material and Methods. Between July, 2015 and December, 2016, 40 eligible patients underwent septal myectomy with subvalvular intervention. The peak gradient was 92.3±16.9 mm Hg. The mean septum thickness was 26.8±4.5 mm. Moderate or severe systolic anterior motion syndrome-mediated mitral regurgitation was observed in all patients.Results. There was no residual mitral regurgitation. Residual systolic anterior motion syndrome was observed in 5%. The postoperative gradient was 8.7±4.5 mm Hg. At 12-month follow-up, all patients were alive. According to the New York Heart Association (NYHA) classification, 87.5 and 12.5% of patients had NYHA functional classes I and II, respectively. The prevalence rate of residual mitral regurgitation was 10%.Conclusions. Concomitant subvalvular intervention during septal myectomy effectively eliminated left ventricular outflow tract obstruction and provided high freedom from residual mitral regurgitation one year after surgery.
肥厚性梗阻性心肌病患者的膈肌切除术与瓣下装置干预:即时效果
的目标。手术中隔肌切除术是肥厚性阻塞性心肌病患者的标准治疗选择。二尖瓣瓣下异常可能在左室流出道梗阻中起重要作用。本研究旨在评估采用瓣下介入治疗的室间隔肌切除术的手术效果。材料和方法。2015年7月至2016年12月,40例符合条件的患者接受了瓣下介入的膈肌切除术。峰值梯度为92.3±16.9 mm Hg,平均鼻中隔厚度为26.8±4.5 mm。所有患者均观察到中度或重度收缩前运动综合征介导的二尖瓣反流。没有残留的二尖瓣返流。残余收缩前运动综合征占5%。术后梯度为8.7±4.5 mm Hg。随访12个月,所有患者均存活。根据纽约心脏协会(NYHA)的分类,87.5%和12.5%的患者分别具有NYHA功能I级和II级。二尖瓣残余返流发生率为10%。在室间隔肌切除术中同时进行瓣下干预有效地消除了左心室流出道阻塞,并在手术后一年内提供了残留二尖瓣反流的高度自由度。
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