Kubota Suguru, Matsui Kinya, Wakasa Satoru, Suto Yukio, Sasaki Shigeyuki, Yoshinaga Keiichiro, Matsui Yoshiro
Department of Cardiovascular Surgery, Hokkaido University Hospital, Sapporo, Hokkaido, Japan.
Ann Thorac Cardiovasc Surg. 2011;17(6):552-8. doi: 10.5761/atcs.oa.11.01695. Epub 2011 Aug 17.
It is not clear whether surgical ventricular restoration (SVR) or procedures approaching mitral complex for controlling functional mitral regurgitation (MR) affect the regional left ventricular wall function. The purpose of the present study was to evaluate the regional LV function after SVR using overlapping left ventriculoplasty (OLVP) using quantitative gated myocardial perfusion SPECT (QGS).
Forty-one heart failure patients, including those with ischemic cardiomyopathy (ICM) (n = 25) and non-ICM (NICM) (n = 16), underwent SVR and/or papillary muscle approximation (PMA). The rest myocardial perfusion SPECT were performed before and early after operation (mean 25.8 ± 10.6 days). These patients were divided into 4 groups based on the surgical procedures (SVR and/or PMA) and etiology of patients (ICM or NICM) as follows: SVR (with or without PMA) of ICM, SVR of NICM, PMA of ICM and PMA of NICM groups. The regional wall thickening was compared before and after the operation between the four groups.
NYHA functional classes were improved after the operation in all four groups. MR grade was also improved in three groups other than SVR of the ICM group. The left ventricular basal wall thickening was improved postoperatively in following three groups (SVR of ICM: 12.7 ± 3.8% to 16.5 ± 4.6% p <0.05, PMA of ICM: 11.1 ± 4.3% to 14.9 ± 4.8% p <0.05, SVR of NICM: 5.8 ± 6.6% to 12.3 ± 6.4% p <0.05), whereas PMA of the NICM group did not show an improvement. Wall thickening in the middle and distal levels was not improved in all groups.
OLVP improved NYHA functional classes, and also improved the regional wall function at the basal level of the left ventricle. In contrast, lone PMA did not improve or impair the regional wall function at any of the levels.
目前尚不清楚手术性心室修复（SVR）或针对控制功能性二尖瓣反流（MR）的二尖瓣复合体相关手术是否会影响左心室局部壁功能。本研究的目的是使用定量门控心肌灌注单光子发射计算机断层扫描（QGS）及重叠左心室成形术（OLVP）来评估SVR术后的左心室局部功能。
41例心力衰竭患者，包括缺血性心肌病（ICM）患者（n = 25）和非缺血性心肌病（NICM）患者（n = 16），接受了SVR和/或乳头肌靠拢术（PMA）。在手术前及术后早期（平均25.8±10.6天）进行静息心肌灌注单光子发射计算机断层扫描。根据手术方式（SVR和/或PMA）及患者病因（ICM或NICM）将这些患者分为4组，如下：ICM的SVR（伴或不伴PMA）组、NICM的SVR组、ICM的PMA组和NICM的PMA组。比较四组手术前后的局部壁增厚情况。
所有四组患者术后纽约心脏协会（NYHA）心功能分级均得到改善。除ICM组的SVR组外，其他三组的MR分级也得到改善。以下三组术后左心室基底壁增厚情况得到改善（ICM的SVR组：从12.7±3.8%增至16.5±4.6%，p<0.05；ICM的PMA组：从11.1±4.3%增至14.9±4.8%，p<0.05；NICM的SVR组：从5.8±6.6%增至12.3±6.4%，p<0.05），而NICM组的PMA未显示出改善。所有组的中间和远端水平的壁增厚均未改善。
OLVP改善了NYHA心功能分级，同时也改善了左心室基底水平的局部壁功能。相比之下，单纯PMA在任何水平均未改善或损害局部壁功能。
