Surgical treatment for hypertrophic obstructive cardiomyopathy complcated with mitral regurgitation abstract
10.3760/cma.j.issn.1001-4497.2019.07.005
- VernacularTitle:肥厚型梗阻性心肌病合并中重度二尖瓣反流的外科治疗
- Author:
Bangrong SONG
1
;
Haiming DANG
;
Xiaoyu XU
;
Ran DONG
Author Information
1. 首都医科大学附属北京安贞医院心脏外科 100029
- Keywords:
Hypertrophic obstructive cardiomyopathy;
Mitral regurgitation;
Cardiac surgery;
Systolic anteri-or motion of mitral value
- From:
Chinese Journal of Thoracic and Cardiovascular Surgery
2019;35(7):406-409
- CountryChina
- Language:Chinese
-
Abstract:
Objective Investigate the therapeutic strategies of hypertrophic obstructive cardiomyopathy ( HOCM ) com-bined with mitral regurgitation(MR).Methods From January 2014 to January 2017, 34 patients with HOCM complicated with moderate to severe MR were enrolled.All patients underwent modified Morrow surgery.Compare the clinical data of pa-tients before and after surgery and the results of one year after surgery .Results There is no patient died during hospitaliza-tion, and all were discharged smoothly without serious complications ( ventricular septal perforation, complete atrioventricular block, etc.) .Results of echocardiography 1 week after surgery suggested: Left ventricular outflow tract pressure difference [(93.36 ±7.93) mmHg vs.(16.73 ±2.02) mmHg,1 mmHg=0.133 kPa, P<0.01], left ventricular outflow tract velocity[(472.40 ±22.12)cm/s vs.(188.40 ±14.16)cm/s, P<0.01], interventricular septal thickness [(19.43 ±0.77) mm vs.(16.45 ±0.76) mm, P<0.01], mitral valve structure and function were good, and MR area [(8.41 ±0.69)cm2 vs. (3.04 ±0.73)cm2, P<0.01], all of which were significantly lower than that before surgery, and the differences were statis-tically significant.Although the results of echocardiography 1 week after surgery indicated that the left ventricular ejection frac-tion(LVEF) was significantly lower than that before surgery(0.67 ±0.07 vs.0.65 ±0.07, P=0.01), the symptoms of the patients were significantly improved, and the cardiac function(NYHA classification) was grade I～II.The results of echocar-diography after 1 year of follow-up suggested that: Left ventricular outflow tract pressure difference [(93.36 ±7.93) mmHg vs.(16.98 ±2.33) mmHg, P<0.01], left ventricular outflow tract velocity [(472.40 ±22.12)cm/s vs.(189.33 ±14.23) cm/s, P<0.01], ventricular septal thickness [(19.43 ±0.77) mm vs.(16.55 ±0.83) mm, P <0.01], mitral valve structure and function well, MR area [(8.41 ±0.69) cm2 vs.(2.95 ±0.66) cm2, P<0.01], and the MR area was signifi-cantly decreased compared with that before operation .The difference was statistically significant .Results of echocardiography 1 week and 1 year after surgery suggest:Left ventricular outflow tract pressure difference [(16.73 ±2.02) mmHg vs.(16.98 ± 2.33) mmHg, P>0.05], left ventricular outflow tract velocity [(188.40 ±14.16)cm/s vs.(189.33 ±14.23)cm/s, P>0.05], ventricular septal thickness [(16.45 ±0.76) mm vs.(16.55 ±0.83) mm, P>0.05], MR area [(3.04 ±0.73) cm2 vs.(2.95 ±0.66) cm2, P>0.05], no statistical significance.One year after the operation, the symptoms and quality of life were significantly improved .Conclusion Hypertrophic obstructive cardiomyopathy often combined with mitral regurgita-tion, modified Morrow operation can fully clear the left ventricular outflow tract, which can eliminate MR and SAM signs, and the results are satisfactory.
