Department of Cardiovascular Surgery, Herzzentrum University Hospital Zürich, Zürich, Switzerland.
Department of Cardiothoracic and Vascular Surgery, Heart and Vascular Institute, Cleveland Clinic Abu Dhabi, Abu Dhabi, United Arab Emirates.
Eur J Cardiothorac Surg. 2018 Apr 1;53(4):700-707. doi: 10.1093/ejcts/ezy020.
Hypertrophic cardiomyopathy is the most common genetic cardiovascular disorder and is associated with symptoms of heart failure and increased risk of sudden cardiac death. The most common condition is obstruction of the left ventricular outflow tract. Surgical septal myectomy and alcohol septal ablation are the 2 accepted modes of septal reduction therapy and are indicated when there are advanced symptoms and a peak left ventricular outflow gradient ≥50 mmHg. Advantages of alcohol septal ablation are limited groin approach, reduction of obstruction of the left ventricular outflow tract and functional improvement, but there are higher chances for intracardiac device implantation and residual obstruction. Septal myectomy offers very low mortality, absolute and immediate resolution of obstruction of the left ventricular outflow tract and survival comparative to a matched general population with almost negligible residual obstruction. It is recommended that patients with obstructive hypertrophic cardiomyopathy should be treated at experienced centres.
肥厚型心肌病是最常见的遗传性心血管疾病，与心力衰竭症状和心源性猝死风险增加相关。最常见的情况是左心室流出道梗阻。外科室间隔心肌切除术和酒精室间隔消融术是两种公认的间隔减少治疗模式，当出现晚期症状和左心室流出道峰值梯度≥50mmHg 时，这两种方法都适用。酒精室间隔消融术的优点是经腹股沟入路有限、减少左心室流出道梗阻和功能改善，但心脏内装置植入和残余梗阻的几率较高。室间隔心肌切除术死亡率非常低，左心室流出道梗阻可立即完全解除，生存率与匹配的一般人群相当，几乎没有残余梗阻。建议梗阻性肥厚型心肌病患者在有经验的中心接受治疗。
