Said Sameh M, Schaff Hartzell V, Abel Martin D, Dearani Joseph A
Division of Cardiovascular Surgery, Mayo Clinic, Rochester, Minnesota, USA.
J Card Surg. 2012 Jul;27(4):443-8. doi: 10.1111/j.1540-8191.2012.01475.x. Epub 2012 May 29.
Apical and midventricular hypertrophic cardiomyopathy (HCM) are rare variants of HCM, in which the hypertrophy is located mainly at the midventricular to apical levels. Heart transplantation was the only possible surgical solution for many of these patients; however, transapical myectomy represents another good alternative. We present our surgical technique of apical ventriculotomy for apical and midventricular myectomy.
A 6-cm incision is made at the apex of the heart lateral to the left anterior descending coronary artery. The apical ventriculotomy provides excellent exposure of the midventricle for midventricular myectomy. The apical approach also allows access to the left ventricle for apical myectomy to enlarge the chamber. During apical myectomy, particular care is necessary to avoid injury to papillary muscles, which are often displaced with apical HCM. Secure closure of the ventriculotomy can be achieved with a double layer of suture reinforced with felt, and no complications of false aneurysm have been observed.
The transapical approach provides excellent exposure of the apex and midventricle, and the technique is useful when myectomy is aimed at eliminating the ventricular obstruction and/or enlarging the left ventricular cavity size in patients with apical hypertrophy.
心尖部和心室中部肥厚型心肌病（HCM）是HCM的罕见变异类型，其肥厚主要位于心室中部至心尖水平。心脏移植曾是许多此类患者唯一可行的手术解决方案；然而，经心尖心肌切除术是另一种不错的选择。我们介绍我们用于心尖部和心室中部心肌切除术的心尖心室切开术的手术技术。
在左前降支冠状动脉外侧的心尖处做一个6厘米的切口。心尖心室切开术能很好地暴露心室中部以便进行心室中部心肌切除术。心尖入路还能进入左心室进行心尖心肌切除术以扩大心室腔。在心尖心肌切除术中，必须特别小心避免损伤乳头肌，乳头肌在HCM心尖部病变时常常移位。用双层缝线加毡片加固可实现心室切开术的牢固缝合，且未观察到假性动脉瘤并发症。
经心尖入路能很好地暴露心尖部和心室中部，当对心尖肥厚患者进行心肌切除术旨在消除心室梗阻和/或扩大左心室腔大小时，该技术很有用。
