Lisboa Luiz Augusto Ferreira, Dallan Luís Alberto Oliveira, Pomerantzeff Pablo Maria Alberto, Oliveiras Sérgio Almeida de, Jatene Fabio Biscegli, Stolf Noedir Antonio Groppo
University of São Paulo School of Medicine (FMUSP).
Rev Bras Cir Cardiovasc. 2011 Jan-Mar;26(1):86-92. doi: 10.1590/s0102-76382011000100016.
This study analyzed the clinical and echocardiographic late outcomes of surgical septal myectomy in patients with obstructive hypertrophic cardiomyopathy (OHCM).
We examined, retrospectively, 34 consecutive adult patients (age 55.7±15.2 years) with OHCM operated on in our institution from 1988 to 2008. Only four (11.8%) patients had family history of OHCM. Nine (26.5%) patients were in New York Heart Association (NYHA) funcional class IV. Thirty (88.2%) patients had solely OHCM, and four (11.8%) had OHCM associated with coronary insufficiency. The surgical technique used in all patients was septal myectomy performed through an aortotomy.
In 26 (76.5%) patients the mitral insufficiency due to systolic anterior motion, decreased after the myectomy. Eight (23.5%) patients had mitral valve procedures. There was one hospitalar death (2.9%). Two (5.9%) patients required permanent pacemaker for complete heart block after the myectomy. The mean peak preoperative left ventricular outflow tract (LVOT) obstruction gradient was 84.9±29.0 mmHg, and decreased to 27.8±12.9 mmHg in the early postoperative and it was 19.2±11.2 mmHg in the late postoperative period (49.0±33.0 months). The NYHA functional class improved from 3.1±0.8 to 1.4±0.5 in the postoperative period. Survival free from death was 87.9% and survival free from cardiovascular events was 77.7% with mean follow-up 9.6±8.4 years.
Surgical septal myectomy can be performed safely, with excellent survival, improvement from symptoms and relief for LVOT obstruction in patients with OHCM. The early benefits were remained at long term.
本研究分析了梗阻性肥厚型心肌病（OHCM）患者行外科室间隔心肌切除术的临床及超声心动图远期结果。
我们回顾性研究了1988年至2008年在我院接受手术的34例连续性成年OHCM患者（年龄55.7±15.2岁）。仅有4例（11.8%）患者有OHCM家族史。9例（26.5%）患者处于纽约心脏协会（NYHA）心功能IV级。30例（88.2%）患者仅患有OHCM，4例（11.8%）患者患有OHCM合并冠状动脉供血不足。所有患者采用的手术技术是经主动脉切口行室间隔心肌切除术。
26例（76.5%）患者因收缩期前向运动导致的二尖瓣关闭不全在心肌切除术后减轻。8例（23.5%）患者接受了二尖瓣手术。有1例医院死亡（2.9%）。2例（5.9%）患者在心肌切除术后因完全性心脏传导阻滞需要永久起搏器。术前左心室流出道（LVOT）梗阻平均峰值压差为84.9±29.0 mmHg，术后早期降至27.8±12.9 mmHg，术后晚期（49.0±33.0个月）为19.2±11.2 mmHg。术后NYHA心功能分级从3.1±0.8改善至1.4±0.5。平均随访9.6±8.4年，无死亡生存率为87.9%，无心血管事件生存率为77.7%。
OHCM患者行外科室间隔心肌切除术可安全进行，生存率高，症状改善，LVOT梗阻缓解。早期获益长期存在。
