Bogachev-Prokophiev A V, Zheleznev S I, Fomenko M S, Sharifulin R M, Afanasyev A V, Malakhova O Yu, Karaskov A M
Acad. E.N. Meshalkin Novosibirsk State Research Institute of Circulaton Pathology, Novosibirsk, Russia.
Kardiologiia. 2017 May;57(5):38-43.
to assess effectiveness and safety of extended myectomy performed in patients with hypertrophic obstructive cardiomyopathy (HOCM) with midventricular obstruction.
Between 2010 and 2013 185 HOCM patients were operated for left ventricular outflow tract (LVOT) obstruction. Among these patients 32 had midventricular obstruction. Their age was 22-74 (mean 51.9+/-14.2) years. Mean peak gradient across LVOT was 89.1+/-20.4 mm Hg, thickness of interventricular septum was 26.9+/-4.3 mm. Operations were guided by intraoperative transesophageal echocardiography (TEE).
There were no early deaths. Gradient at LVOT according to TEE decreased to 15.4+/-5.7 mm Hg. There were no complications specific for extended myectomy (such as ventricular septal defect, left ventricular wall rupture, or aortic regurgitation). In 2 (6.9%) patients permanent pacemaker was implanted because of complete atrio-ventricular block. Mean follow-up was 18.7 (95% confidence interval [CI] 17.2 to 20.3) months. Kaplan-Meier estimate of survival was 100% at 12 and 94.2% (95% CI 65.8-99.1%) at 22 months.
Extended myectomy can be safely and effectively performed in HOCM patients with midventricular obstruction and should be considered individually in each patient.
评估对患有肥厚性梗阻性心肌病（HOCM）且伴有心室中部梗阻的患者进行扩大性心肌切除术的有效性和安全性。
2010年至2013年间，185例HOCM患者因左心室流出道（LVOT）梗阻接受手术。其中32例患者伴有心室中部梗阻。他们的年龄为22 - 74岁（平均51.9±14.2岁）。LVOT平均峰值压差为89.1±20.4 mmHg，室间隔厚度为26.9±4.3 mm。手术在术中经食管超声心动图（TEE）引导下进行。
无早期死亡病例。根据TEE测量，LVOT压差降至15.4±5.7 mmHg。没有扩大性心肌切除术特有的并发症（如室间隔缺损、左心室壁破裂或主动脉瓣反流）。2例（6.9%）患者因完全性房室传导阻滞植入了永久性起搏器。平均随访时间为18.7个月（95%置信区间[CI]为17.2至20.3个月）。Kaplan - Meier生存估计显示，12个月时生存率为100%，22个月时为94.2%（95% CI为65.8 - 99.1%）。
对于患有心室中部梗阻的HOCM患者，扩大性心肌切除术可以安全有效地进行，且应针对每位患者进行个体化考虑。
