Totally endoscopic transmitral septal myectomy for the treatment of recurrent left ventricular outflow tract obstruction after alcohol septal ablation
- VernacularTitle:全胸腔镜经二尖瓣行室间隔心肌切除术治疗室间隔酒精消融术后复发左室流出道梗阻
- Author:
Peijian WEI
1
,
2
,
3
;
Hongxiang WU
2
,
4
;
Tong TAN
1
,
2
,
3
;
Hailong QIU
2
,
5
,
6
,
7
;
Xiaowei XU
7
,
8
;
Wei ZHU
2
,
9
;
Guanyu LU
7
,
10
,
11
;
Jian ZHUANG
2
,
5
,
6
,
7
;
Jian LIU
2
,
5
,
6
,
7
;
Huiming GUO
2
,
5
,
6
,
7
Author Information
1. 1.Department of Cardiac Surgery, Guangdong Provincial People&rsquo
2. s Hospital, Guangdong Academy of Medical Sciences, Guangdong Cardiovascular Institute, Guangzhou, 510080, P. R. China
3. 2. Shantou University Medical College, Shantou, 515041, Guangdong, P. R. China
4. Department of Cardiac Surgery, Guangdong Provincial People&rsquo
5. 1. Department of Cardiac Surgery, Guangdong Provincial People&rsquo
6. 3. Laboratory of Artificial Intelligence and 3D Technologies for Cardiovascular Diseases, Guangdong Provincial Key Laboratory of South China Structural Heart Disease, Guangdong Provincial People&rsquo
7. s Hospital, Guangdong Academy of Medical Sciences, Guangzhou, 510080, P. R. China
8. Laboratory of Artificial Intelligence and 3D Technologies for Cardiovascular Diseases, Guangdong Provincial Key Laboratory of South China Structural Heart Disease, Guangdong Provincial People&rsquo
9. Department of Adult Cardiac Ultrasound Medicine, Guangdong Provincial People&rsquo
10. 2. Shantou University Medical College, Shantou, 515041, Guangdong, P. R. China
11. 5. Department of Radiology, Guangdong Provincial People&rsquo
- Publication Type:Journal Article
- Keywords:
Totally endoscopic;
septal myectomy;
alcohol septal ablation;
residual left ventricular outflow tract obstruction;
three-dimensional printing
- From:
Chinese Journal of Clinical Thoracic and Cardiovascular Surgery
2023;30(08):1102-1111
- CountryChina
- Language:Chinese
-
Abstract:
Objective To investigate the surgical strategies and clinical efficacy of transmitral septal myectomy in the treatment of recurrent left ventricular outflow tract obstruction (LVOTO) after alcohol septal ablation. Methods The clinical data of patients with recurrent LVOTO after alcohol septal ablation from July 2020 to July 2021 in the Department of Cardiac Surgery, Guangdong Provincial People's Hospital were retrospectively analyzed. Patients were preoperatively evaluated by echocardiography, cardiac magnetic resonance imaging, cardiac computed tomography, 3D modeling and printing technology. A personalized surgical strategy was preoperatively developed according to multimodality imaging assessment, while visual exploration was performed on the digital model and simulated surgical resection was performed on the printed model. Results Two female patients were enrolled, aged 62 years and 64 years, respectively. Totally endoscopic transmitral extended myectomy was successfully performed on both patients with aortic cross-clamping time of 96 min and 85 min, respectively. LVOTO was relieved immediately (subaortic peak pressure gradient decreased from 100 mm Hg to 4 mm Hg and from 84 mm Hg to 6 mm Hg, respectively) and the mitral regurgitation significantly improved after the procedure. No patient had complete atrioventricular block or required permanent pacemaker implantation. The patients were discharged uneventfully without postoperative complications. Conclusion Personalized totally endoscopic transmitral extended myectomy combined with multimodality imaging assessment and 3D modeling and printing has an acceptable clinical effect in patients with recurrent LVOTO after alcohol septal ablation. The procedure can precisely resect the hypertrophic septal myocardium while avoiding serious complications such as septal perforation or complete atrioventricular block.
