Havndrup O, Pettersson G, Kjeldsen K, Bundgaard H
Department of Medicine B, H:S Rigshospitalet, University of Copenhagen, Denmark.
Scand Cardiovasc J. 2000 Dec;34(6):564-9. doi: 10.1080/140174300750064486.
To study the outcome of septal myectomy in patients with hypertrophic obstructive cardiomyopathy.
Septal myectomy in patients with hypertrophic cardiomyopathy with obstruction of the left ventricular outflow tract (HOCM) is symptomatically effective, and complication rates have been found to be low in large centres performing the procedure routinely. Representing a small centre we studied the outcome after septal myectomy in 11 consecutive patients, aged 44 +/- 21 (mean +/- SD) years with HOCM myectomized at our institution from 1991 to 1998. The patients were evaluated preoperatively using echocardiography and left-sided heart catheterization.
Eight patients were operated on after medical treatment had failed and three after sudden deterioration of cardiac function. A Morrow myectomy was performed in 10 patients and a modified Konno procedure in one. Significant reductions were observed in left ventricular outflow tract gradients (77 +/- 29 to 10 +/- 7 mmHg, p < 0.01; n = 11), the degree of mitral valve regurgitation (grades 0-3) (1.7 +/- 1.0 to 0.8 +/- 0.7, p < 0.01; n = 11), NYHA functional classification score (2.4 +/- 1.0 to 1.5 +/- 0.7, p < 0.01; n = 11) and all five patients with angina preoperatively had an improved CCS angina classification score. There were no operative or early postoperative (30 days) deaths. One patient operated on with the modified Konno procedure was reoperated for a septal patch suture leak. During follow-up (43 +/- 24 months, range 11-83), the linearized mortality rate was 3.6% per year. One patient died from a pancreas cancer, one probably from coronary artery disease and one suddenly of unknown cause.
We conclude that septal myectomy efficiently relieves symptoms in HOCM patients, possibly reflecting the direct as well as secondary effects of left ventricular outflow tract gradient reduction. The present results, obtained at a smaller centre for this procedure, should be considered when choosing from available therapeutic alternatives when medical therapy fails: dual chamber pacemaker implantation, percutaneous transluminal septal myocardial ablation or myectomy.
研究肥厚性梗阻性心肌病患者行室间隔心肌切除术的结果。
对于有左心室流出道梗阻的肥厚性心肌病（HOCM）患者，室间隔心肌切除术在缓解症状方面是有效的，并且在常规开展该手术的大型中心发现并发症发生率较低。作为一个小型中心，我们研究了1991年至1998年在我院接受室间隔心肌切除术的11例连续患者的结果，这些患者年龄为44±21（平均±标准差）岁，患有HOCM。术前通过超声心动图和左心导管检查对患者进行评估。
8例患者在药物治疗失败后接受手术，3例在心脏功能突然恶化后接受手术。10例患者行Morrow心肌切除术，1例患者行改良Konno手术。观察到左心室流出道梯度显著降低（从77±29降至10±7 mmHg，p<0.01；n = 11），二尖瓣反流程度（0 - 3级）降低（从1.7±1.0降至0.8±0.7，p<0.01；n = 11），纽约心脏协会（NYHA）功能分级评分降低（从2.4±1.0降至1.5±0.7，p<0.01；n = 11），术前所有5例心绞痛患者的加拿大心血管学会（CCS）心绞痛分级评分均有所改善。无手术或术后早期（30天）死亡病例。1例行改良Konno手术的患者因室间隔补片缝合渗漏而再次手术。在随访期间（43±24个月，范围11 - 83个月），线性化死亡率为每年3.6%。1例患者死于胰腺癌，1例可能死于冠状动脉疾病，1例原因不明突然死亡。
我们得出结论，室间隔心肌切除术能有效缓解HOCM患者的症状，这可能反映了左心室流出道梯度降低的直接及继发效应。在选择药物治疗失败时可用的治疗方案（双腔起搏器植入、经皮腔内室间隔心肌消融或心肌切除术）时，应考虑本小型中心获得的当前结果。
