Wang Shui-Yun, Cui Bin, Sun Han-Song, Song Yun-Hu, Sun Li-Zhong, Xu Jian-Ping, Wang Wei, Hu Sheng-Shou
CAMS & PUMC, Fu wai Hospital, Beijing 100037, China.
Zhonghua Yi Xue Za Zhi. 2009 Oct 27;89(39):2776-8.
To evaluate the surgical outcome of hypertrophic obstructive cardiomyopathy (HOCM).
From October 1996 to December 2007, 54 HOCM patients underwent surgical treatment. There were 37 males and 17 females ranging from 6 to 68 years old (36 +/- 16) with body weight 27-83 (60 +/- 14) kg. Operation was performed under general anesthesia and cardiopulmonary bypass (CPB) with the moderate systemic temperature and low volume blood flow. The concomitant operations included coronary artery bypass grafting in 5 cases, mitral valve plasty in 5 cases, mitral valve replacement in 9 cases, tricuspid valve plasty in 2 cases, aortic valve replacement in 4 cases and closure of patent ductus arteriosus in 2 cases. Preoperative and postoperative left ventricular (LV), left ventricular outflow tract (LVOT), left atrium (LA), mitral valve function and value of LVEF were evaluated by transesophageal echocardiograph examination.
The time of CPB and aortic occlusion were 40 to 290 minutes (107 +/- 52) and 27 to 195 min (70 +/- 36 min) respectively. The endotracheal intubation durations were 5 to 21 hours (14 +/- 15) and ICU duration 11 to 183 hours (45 +/- 34). Comparing with the pre-operative echocardiographic parameters, the size of left atrium (42 +/- 8 vs 35 +/- 7), pressure gradients through LVOT (106 +/- 44 mm Hg vs 24 +/- 19 mm Hg), the thickness of septum (27 +/- 6 mm vs 19 +/- 5 mm) and the value of EF (70 +/- 10 vs 61 +/- 9) obviously decreased postoperatively (P < 0.05). The surviving patients had either no mitral valve regurgitation or only mild mitral valve regurgitation. Four (7.4%) patients died during the perioperative period. The cause of death included severe low cardiac output, heart failure, severe ventricular arrhythmias and severe acute renal failure. There were 4 patients with a complete AV block postoperatively and 3 were implanted permanent pacemakers. The left bundle branch block or left anterior hemiblock were found in 26 cases, intraventricular conduction defect in 6 cases and type I AV block in 4 cases. All surviving patients were in NYHA functional class I/II during the follow-up of 1 month to 10 years.
Surgical outcome for HOCM patients is satisfactory. Most HOCM patients achieve such a satisfactory relief of LV outflow tract obstruction as to lead a better life.
评估肥厚性梗阻性心肌病（HOCM）的手术疗效。
1996年10月至2007年12月，54例HOCM患者接受了手术治疗。其中男性37例，女性17例，年龄6至68岁（36±16岁），体重27至83千克（60±14千克）。手术在全身麻醉和体外循环（CPB）下进行，采用中度体循环温度和低流量血流。同期手术包括冠状动脉搭桥术5例、二尖瓣成形术5例、二尖瓣置换术9例、三尖瓣成形术2例、主动脉瓣置换术4例和动脉导管未闭封堵术2例。通过经食管超声心动图检查评估术前和术后左心室（LV）、左心室流出道（LVOT）、左心房（LA）、二尖瓣功能及左心室射血分数（LVEF）值。
CPB时间和主动脉阻断时间分别为40至290分钟（107±52分钟）和27至195分钟（70±36分钟）。气管插管时间为5至21小时（14±15小时），重症监护病房（ICU）停留时间为11至183小时（45±34小时）。与术前超声心动图参数相比，术后左心房大小（42±8 vs 35±7）、LVOT压力阶差（106±44 mmHg vs 24±19 mmHg）、室间隔厚度（27±6 mm vs 19±5 mm）及EF值（70±10 vs 61±9）明显降低（P<0.05）。存活患者二尖瓣无反流或仅有轻度二尖瓣反流。围手术期死亡4例（7.4%）。死亡原因包括严重低心排血量、心力衰竭、严重室性心律失常和严重急性肾衰竭。术后有4例完全性房室传导阻滞，3例植入永久性起搏器。发现左束支传导阻滞或左前分支阻滞26例，室内传导阻滞6例，I度房室传导阻滞4例。所有存活患者在1个月至10年的随访期间均处于纽约心脏协会（NYHA）心功能I/II级。
HOCM患者的手术疗效满意。多数HOCM患者左心室流出道梗阻得到满意缓解，生活质量改善。
