Long-term effect of modified Morrow surgery on hypertrophic obstructive cardiomyopathy in children: A retrospective study in a single center
- VernacularTitle:改良Morrow术治疗儿童肥厚型梗阻性心肌病远期疗效的单中心回顾性研究
- Author:
Xiaoyi LI
1
,
2
;
Hongxiang WU
1
,
2
;
Ruobing WANG
1
,
2
;
Haozhong LIU
1
,
2
;
Xiaodong ZENG
1
,
2
;
Ying ZENG
3
,
4
;
Shengwen WANG
1
,
2
;
Minjie HUANG
1
,
2
;
Haiyun YUAN
2
,
3
,
5
;
Jian LIU
2
,
3
,
5
;
Huiming GUO
2
,
3
,
5
Author Information
1. Department of Cardiac Surgery, Guangdong Institute of Cardiovascular Disease, Guangdong Academy of Medical Sciences, Guangdong Provincial People'
2. s Hospital, Southern Medical University, Guangzhou, 510080, P. R. China
3. 1.Department of Cardiac Surgery, Guangdong Institute of Cardiovascular Disease, Guangdong Academy of Medical Sciences, Guangdong Provincial People'
4. s Hospital, Southern Medical University, Guangzhou, 510080, P. R. China 3. School of Medicine, South China University of Technology, Guangzhou, 510641, P. R. China
5. s Hospital, Southern Medical University, Guangzhou, 510080, P. R. China 2. Guangdong Provincial Key Laboratory of Structural Heart Diseases in South China, Guangdong Academy of Medical Sciences, Guangdong Provincial People'
- Publication Type:Journal Article
- Keywords:
Hypertrophic cardiomyopathy;
children;
interventricular septal cardiomyectomy;
pacemaker
- From:
Chinese Journal of Clinical Thoracic and Cardiovascular Surgery
2024;31(07):985-990
- CountryChina
- Language:Chinese
-
Abstract:
Objective To analyze the long-term outcome of modified Morrow surgery (interventricular septal cardiomyectomy) in the treatment of hypertrophic obstructive cardiomyopathy (HOCM) in children. Methods The clinical data of the children with HOCM (aged≤14 years) who underwent modified Morrow surgery from January 2010 to August 2022 in Guangdong Provincial People's Hospital were retrospectively analyzed, including changes in hospitalization status, perioperative period, and long-term 15-lead electrocardiogram and echocardiography. Results A total of 29 patients were collected, including 22 males and 7 females, aged 10.00 (5.00, 12.00) years. Five (17.9%) patients had New York Heart Association (NYHA) heart function grade Ⅲ or Ⅳ. Ventricular septal cardiomyectomy was performed in all patients. All 29 patients survived and their cardiac function recovered after operation. Before discharge, right bundle branch block was observed in 2 patients and left bundle branch block in 6 patients. After surgery, in the left ventricular septal cardiomyectomy, the left atrial diameter decreased (P＜0.001), left ventricular end-systolic diameter increased (P=0.009), the peak pressure gradient of left ventricular outflow tract decreased (P＜0.001), and the thickness of ventricular septum decreased (P＜0.001). The systolic anterior motion of mitral valve disappeared and mitral regurgitent jet area decreased (P＜0.001). The flow velocity and peak pressure gradient of right ventricular outflow tract also decreased in the patients who underwent right ventricular septal cardiomyectomy. The average follow-up of the patients was 69.03±10.60 months. All the patients survived with their NYHA cardiac function grading Ⅰ or Ⅱ. No new-onset arrythmia event was found. Echocardiography indicated that the peak pressure gradient of the left ventricular outflow tract remained low (P<0.001). Moderate mitral regurgitation occurred in 2 patients, and left ventricular outflow tract obstruction with moderate mitral regurgitation occurred in 1 patient after simple right ventricular septal cardiomyectomy. Conclusion Right ventricular or biventricular obstruction is frequent in the children with HOCM and they usually have more symptoms before surgery. Modified Morrow surgery can effectively relieve outflow tract obstruction and improve their cardiac function. The long-term outcome is satisfactory. However, the posterior wall of the left ventricle remains hypertrophic. Also, there is an increased risk of a conduction block.
