伴有与不伴有明显室间隔肥厚的肥厚性心肌病的手术切除和二尖瓣修复的结果

IF 2.5 Q2 CARDIAC & CARDIOVASCULAR SYSTEMS

CJC Open Pub Date : 2025-07-01 DOI:10.1016/j.cjco.2025.04.007

Kenza Rahmouni MDCM , Hugo M.N. Issa MD , Omar Toubar , Andrew M. Crean MD, MPH , Anne Williams MD , Hanh Nguyen MD , Menaka Ponnambalam RN(EC), NP , Juan Grau MD , Sean Dickie MD , Gyaandeo Maharajh MDCM , Marc Ruel MD, MPH

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引用次数: 0

摘要

本研究报告了一个单一机构对肥厚性心肌病（HCM）和左心室流出道（LVOT）梗阻患者行室间隔肌切除术合并vs不合并二尖瓣干预的临床和超声心动图结果。方法纳入2019年10月至2024年3月期间连续接受经主动脉间隔肌切除术合并vs无瓣下二尖瓣介入治疗HCM的患者。所有患者均行经食管超声心动图和心脏磁共振成像以确认病理、测量腔内梯度和评估二尖瓣形态。将患者作为整个队列进行分析，并通过标记(>；15mm)或仅轻度（≤15mm）间隔肥厚。结果共纳入61例患者（男性32例），其中28例（45.9%）有轻度中隔肥厚。随访评估100%完成，平均26.9±16.2个月。除中隔肌切除术外，32例（52.5%）患者同时行乳头状肌调整术，40例（65.6%）患者行异常脊索切除术。所有鼻中隔厚度≤15mm的患者均行二尖瓣修复干预。30天和2年死亡率分别为1.6%和3.3%。术后未发生室间隔缺损，包括薄室间隔亚组。术前和术后LVOT峰值梯度均显著降低（术前47.8±34.7 mm Hg vs术后8.8±12.3 mm Hg）， P <；0.001)和应激(术前114.2±58.7 mm Hg vs术后17.6±18.5 mm Hg, P <；0.001)。结论对于有症状的HCM患者，即使没有明显的室间隔肥大，室间隔肌切除术联合二尖瓣介入治疗是安全的，并能很好地缓解LVOT阻塞。

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Outcomes of Surgical Myectomy and Mitral Valve Repair for Hypertrophic Cardiomyopathy With vs Without Marked Septal Hypertrophy

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Outcomes of Surgical Myectomy and Mitral Valve Repair for Hypertrophic Cardiomyopathy With vs Without Marked Septal Hypertrophy

Background

This study reports a single institution’s clinical and echocardiographic outcomes for septal myectomy with vs without concomitant mitral valve interventions in patients with hypertrophic cardiomyopathy (HCM) and left ventricular outflow tract (LVOT) obstruction.

Methods

Consecutive patients who underwent transaortic septal myectomy with vs without subvalvular mitral apparatus intervention for HCM between October 2019 and March 2024 were included. All patients underwent transesophageal echocardiography and cardiac magnetic resonance imaging to confirm the pathology, measure intracavitary gradients, and assess mitral valve morphology. Patients were analyzed as an entire cohort and stratified by the presence of marked (> 15 mm) or only mild (≤ 15 mm) septal hypertrophy.

Results

A total of 61 patients (32 male) were included, of whom 28 (45.9%) had mild septal hypertrophy. The follow-up assessment was 100% complete and averaged 26.9 ± 16.2 months. In addition to septal myectomy, 32 patients (52.5%) underwent concomitant papillary muscle realignment, and aberrant chordae were resected in 40 patients (65.6%). All patients with a septal thickness ≤ 15 mm had a mitral valve repair intervention. The 30-day and 2-year mortality were 1.6% and 3.3%, respectively. No postoperative ventricular septal defects occurred, including in the thin septum subgroup. Peak LVOT gradients were significantly reduced with surgery, both at rest (47.8 ± 34.7 mm Hg preoperatively vs 8.8 ± 12.3 mm Hg postoperatively, P < 0.001) and under stress (114.2 ± 58.7 mm Hg preoperatively vs 17.6 ± 18.5 postoperatively, P < 0.001).

Conclusions

In patients with symptomatic HCM, even in those without marked septal hypertrophy, septal myectomy with a concomitant mitral valve apparatus intervention is safe and provides excellent relief of LVOT obstruction.

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