Sasson Z, Prieur T, Skrobik Y, Fulop J C, Williams W G, Henderson M A, Gresser C, Wigle E D, Rakowski H
Division of Cardiology, Toronto General Hospital, Ontario, Canada.
J Am Coll Cardiol. 1989 Jan;13(1):63-7. doi: 10.1016/0735-1097(89)90550-0.
Surgical ventriculomyectomy and ventriculomyotomy by the aortic approach are safe and effective methods of relieving symptoms and obstruction to left ventricular outflow in patients with hypertrophic obstructive cardiomyopathy. With the addition of Doppler ultrasound to the routine follow-up assessment of these patients an unexpectedly high occurrence of aortic regurgitation was found in the postoperative patients. Because aortic regurgitation has been reported to rarely accompany this condition, 67 patients with hypertrophic obstructive cardiomyopathy were studied clinically and with Doppler echocardiography for the presence and severity of aortic regurgitation. Severity of the regurgitation was quantitated by pulsed or color Doppler echocardiography according to the length and width of the regurgitant jet in at least two views. In 37 patients with hypertrophic obstructive cardiomyopathy who did not undergo surgery, aortic regurgitation was detected in only 1 (3%) by Doppler ultrasound and in none clinically. In 52 patients who did undergo surgery and were studied a mean of 7.8 years postoperatively, aortic regurgitation of trivial to moderate degree was common, being detected in 28 (54%) by Doppler ultrasound and in 6 (12%) clinically. In a subgroup of 22 patients who were studied preoperatively and again early postoperatively (mean 6 weeks), new aortic regurgitation was found in 8 (36%) and was graded as trivial in all. Aortic regurgitation is a common complication related to ventriculomyectomy and ventriculomyotomy in patients with hypertrophic obstructive cardiomyopathy. Although initially trivial, the regurgitation may progress in severity over time. The regurgitation has been well tolerated in all patients studied to date.
经主动脉途径进行的外科心室肌切除术和心室肌切开术是缓解肥厚性梗阻性心肌病患者症状及左心室流出道梗阻的安全有效方法。在对这些患者的常规随访评估中增加多普勒超声检查后，发现术后患者中主动脉瓣反流的发生率出乎意料地高。由于据报道主动脉瓣反流很少伴随这种疾病，因此对67例肥厚性梗阻性心肌病患者进行了临床和多普勒超声心动图检查，以确定主动脉瓣反流的存在及其严重程度。反流的严重程度通过脉冲或彩色多普勒超声心动图，根据至少两个视图中反流束的长度和宽度进行定量。在37例未接受手术的肥厚性梗阻性心肌病患者中，通过多普勒超声仅检测到1例（3%）有主动脉瓣反流，临床检查未发现。在52例接受手术且术后平均7.8年接受研究的患者中，轻度至中度主动脉瓣反流很常见，通过多普勒超声检测到28例（54%），临床检查发现6例（12%）。在一个术前及术后早期（平均6周）再次接受研究的22例患者亚组中，发现8例（36%）有新的主动脉瓣反流，且均为轻度。主动脉瓣反流是肥厚性梗阻性心肌病患者心室肌切除术和心室肌切开术相关的常见并发症。尽管最初较轻，但反流程度可能会随时间进展。迄今为止，所有研究的患者对反流耐受性良好。
