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[肥厚型心肌病手术策略的演变:8例患者的病例研究]

[Evolution of the surgical strategy in hypertrophic cardiomyopathy: case studies of eight patients].

作者信息

Joudinaud Thomas, Flecher Erwan, Hvass Ulrich

机构信息

Service de chirurgie cardiaque, hôpital Bichat, 46, rue Henri-Huchard, 75018 Paris, France.

出版信息

Ann Cardiol Angeiol (Paris). 2008 Feb;57(1):16-21. doi: 10.1016/j.ancard.2007.08.016. Epub 2007 Nov 5.

Abstract

INTRODUCTION

Hypertrophic cardiomyopathy is an inherited disease characterized by a left ventricular hypertrophy, a diastolic dysfunction and rhythm troubles with risk of sudden death. There was an evolution in the surgical strategy to treat the patients who present a left ventricular outflow tract gradient.

MATERIALS AND METHODS

A retrospective study was conducted: We selected eight cases who presented an hypertrophic cardiomyopathy and operated on. Pre and post operative echocardiographic data were analysed. Follow up was obtained by call or mail to the cardiologist.

RESULTS

The patients were classified in four groups: isolated left ventricular outflow tract obstruction, left ventricular outflow tract obstruction and associated lesions, obstructive hypertrophic cardiomyopathy and endocarditis, post operative complications of the hypertrophic cardiomyopathy surgery. We observed a significant decrease of the left ventricular outflow tract mean gradient in the post operative period and at four years.

CONCLUSION

Surgical management of obstructive hypertrophic cardiomyopathy remain an important option in young patients, in case of failure of the ethanol septal ablation or in patients who present other surgical lesions. The dual chamber stimulation remain indicated in old patients.

摘要

引言

肥厚型心肌病是一种遗传性疾病,其特征为左心室肥厚、舒张功能障碍以及有猝死风险的心律失常。在治疗出现左心室流出道压差的患者时,手术策略有所演变。

材料与方法

进行了一项回顾性研究:我们选取了8例患有肥厚型心肌病并接受手术治疗的病例。分析了术前和术后的超声心动图数据。通过致电或发邮件给心脏病专家进行随访。

结果

患者被分为四组:孤立性左心室流出道梗阻、左心室流出道梗阻及相关病变、梗阻性肥厚型心肌病合并心内膜炎、肥厚型心肌病手术的术后并发症。我们观察到术后及四年时左心室流出道平均压差显著降低。

结论

对于梗阻性肥厚型心肌病,在酒精性室间隔消融术失败或存在其他外科病变的患者中,手术治疗仍是年轻患者的重要选择。双腔起搏仍适用于老年患者。

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