改良手术治疗伴有明显二尖瓣反流的肥厚性梗阻性心肌病

Chinese Journal of Thoracic and Cardiovaescular Surgery Pub Date : 2019-10-25 DOI:10.3760/CMA.J.ISSN.1001-4497.2019.10.003

Zhaolei Jiang, J. Mei, M. Tang, N. Ma, Hao Liu, Sai'e Shen, Fang-bao Ding, Chunrong Bao

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引用次数: 0

摘要

目的总结单次经主动脉入路改良手术治疗肥厚性阻塞性心肌病(HOCM)合并二尖瓣返流(MR)的安全性和效果。方法2008年1月至2018年6月，93例HOCM和显著MR患者通过单次经主动脉入路行改良Morrow手术和边缘到边缘二尖瓣成形术。术前左室流出道压力梯度(LVOTPG)为51 ~ 199 mmHg(1 mmHg=0.133 kPa)。术前室间隔厚度(IVST) 17 ~ 30mm。所有患者均有明显MR伴SAM现象。在体外循环和主动脉夹持下，通过单次经主动脉入路进行改良的Morrow手术和边缘到边缘二尖瓣成形术。结果所有患者均成功行改良Morrow手术及经主动脉单侧瓣瓣边缘成形术。无早期死亡和室间隔穿孔发生。术后早期，2例(2.15%)患者因完全性房室传导阻滞接受永久性起搏器植入。出院时LVOTPG(7 ~ 31 mmHg)、IVST(11 ~ 19 mm)较术前明显降低(P<0.05)。所有患者均无mr或轻度mr，二尖瓣压力梯度(MVPG)为0 ~ 6 mmHg。所有患者均无SAM现象。平均随访(40.53±27.11)个月，无明显左室流出道残留梗阻。所有患者均无或轻微MR. SAM现象发生。结论改良的Morrow手术及单侧经主动脉入路二尖瓣边缘成形术可安全有效地治疗HOCM合并显著mr患者。关键词:肥厚性阻塞性心肌病;二尖瓣返流;边对边;二尖瓣瓣膜成形术

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Modified surgery for hypertrophic obstructive cardiomyopathy with concomitantly significant mitral regurgitation through a single transaortic approach

Objective To summarize the safety and effect of modified surgery for hypertrophic obstructive cardiomyopathy(HOCM) with concomitantly significant mitral regurgitation(MR) through a single transaortic approach. Methods From January 2008 to June 2018, 93 patients with HOCM and significant MR underwent modified Morrow procedure and edge-to-edge mitral valvuloplasty through a single transaortic approach. Preoperative left ventricular outflow tract pressure gradient(LVOTPG) was 51-199 mmHg(1 mmHg=0.133 kPa). Preoperative interventricular septum thickness(IVST) was 17-30 mm. All patients had significant MR with SAM phenomenon. The modified Morrow procedure and edge-to-edge mitral valvuloplasty through a single transaortic approach was performed under cardiopulmonary bypass and aortic crossclamp. Results All patients successfully underwent the surgery of modified Morrow procedure and edge-to-edge mitral valvuloplasty through a single transaortic approach. No early death and interventricular septal perforation were occurred. In the early postoperative period, two patient(2.15%) received permanent pacemaker implantation due to the complete atrial-ventricular block. At discharge, postoperative LVOTPG(7-31 mmHg) and IVST(11-19 mm) were significantly decreased compared with the preoperative values(P<0.05). All patients had none or trivial MR. The mitral valve pressure gradient(MVPG) was 0-6 mmHg. SAM phenomenon disappeared in all patients. At a mean follow-up of(40.53±27.11) months, no patient had significant residual left ventricular outflow tract obstruction. All patients had none or trivial MR. No SAM phenomenon occurred. Conclusion Modified surgery of Morrow procedure and edge-to-edge mitral valvuloplasty through a single transaortic approach could be safely and effectively applied for patients with HOCM and concomitantly significant MR. Key words: Hypertrophic obstructive cardiomyopathy; Mitral regurgitation; Edge to edge; Mitral valvuloplasty

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Chinese Journal of Thoracic and Cardiovaescular Surgery

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