Myomectomy and mitral plasty for mitral abnormalities in hypertrophic obstructive cardiomyopathy
10.3760/cma.j.issn.1001-4497.2010.06.003
- VernacularTitle:肥厚梗阻性心肌病合并二尖瓣病变的外科治疗
- Author:
Bin CUI
;
Jianping XU
;
Wei WANG
;
Feng LV
;
Hui XIONG
;
Shuiyun WANG
- Publication Type:Journal Article
- Keywords:
Cardiomyopathy hypertrophic;
Mitral valve insufficiency;
Cardiac surgical procedures;
Systolic anterior movement
- From:
Chinese Journal of Thoracic and Cardiovascular Surgery
2010;26(6):368-370,379
- CountryChina
- Language:Chinese
-
Abstract:
Objective analysis the pathogenesis and the treatment strategies of the hypertrophic obstructive cardiomyopathy (HOCM) with the concomitant mitral valve abnormalities. Methods From October 1996 to June 2009, 62 patients suffered from HOCM underwent surgical treatment. There were 41 males and 21 females with age ranging from 6 to 68 ( 34.05 ±15.26) years old. The body weight were 27 -83 kg [mean (60. 42 ± 12.71 ) kg]. Detected by preoperative echocardiography, all patients had the systolic anterior movement of the mitral leaflet ( SAM ) and 50 patients had mitral regurgitation (MR). Ventricular septal myomectomy was performed under general anesthesia and cardiopulmonary bypass (CPB) with a moderate systemic temperature and low volume blood flow. The concomitant operations included mitral valve replacement ( MVR 12 cases), mitral valve plasty ( MVP9 cases). During the perioperative period the patients were evaluated by echocardiography. Left ventricle ( LV ), left ventricular outflow tract ( LVOT), left atrium ( LA ), left ventricalar ejection fraction ( LVEF), mitral valve construction and function were evaluated. Results The time of CPB and the sortic occlusion were (104.23 ±47.14) (402290) min and (66.76 ±36.32) (20-195) min, respectively. The endotracheal intubation time was ( 13.23 ± 11.76 ) ( 5 -21 ) h and ICU stay was (42.53 ± 37.41 ) ( 11 ～ 183 ) h. Comparing with the parameters before operation: the sizes of the LA were (43.46 ± 7.21 ) mm vs. ( 34.56 ± 6.45 ) mm, pressure gradients through LVOT ( 103.84 ±44.04) mm Hg vs. (23.54±17.78) mm Hg and the thickness of the septal (26.93±5.23) mm vs. (17.12±5.67) mm.All parameters were significantly decreased( P ＜0.05 )postoperatively. All surviving patients had no or only trivial MR and SAM. Four patients (6.4% ,4/62 ) died during the perioperative period. The cause of death included severe low cardiac output, heart failure, severe ventricular arrhythmias and severe acute renal failure. The main complications were: left bandle branch block in 33 cases, intraventricular conduction block in 7, complete AV block in 6, anterior hemiblock in 5, type Ⅰ artioventricular conduction block in5, atrial fibrillation in 4. All surviving patients were in New York Heart Association functional class Ⅰ or Ⅱ during the follow-up from 1 month to 10 years. Cardiac symptoms were markedly relieved. Mitral valve construction and function were significantly improved. There were no death, no complications and none required additional mitral valve or myecomy surgery. Conclusion Ventricular septal myomectomy alone is sufficient to eliminate or significantly reduce the severity of MR and SAM. In patients with HOCM and MR due to the congenital mitral valve disease, concomitant MVP may be the first choice. Considering the inherent risks of prosthetic valves and anticoagulation complications, MVR should be the second choice.
