Song Bang-Rong, Ren Yanlong, Zhang Hong-Jia
Department of Cardiac Surgery, Beijing Anzhen Hospital, Capital Medical University, Beijing 100029, China.
Department of Cardiology, Beijing Anzhen Hospital, Capital Medical University, Beijing 100029, China.
Heart Surg Forum. 2018 Nov 7;21(6):E443-E447. doi: 10.1532/hsf.2013.
We sought to analyze the pathological characteristics of hypertrophic obstructive cardiomyopathy (HOCM) with concomitant mitral valve abnormalities and to discuss the surgical treatment strategies.
The clinical data of 26 HOCM patients treated from January 2014 to March 2016 were retrospectively analyzed. There were 19 males and 7 females with a mean age of 47 ± 16 years (range, 10-70 years). Echocardiography showed HOCM, systolic anterior motion of the mitral apparatus, and concomitant mitral regurgitation. Modified Morrow procedure with expanded resection area was performed in 21 patients. Concomitant mitral valvuloplasty was performed in 4 patients, coronary artery bypass grafting was performed in one patient, and aortic valve replacement was performed in one patient. Echocardiography was performed intraoperatively at postoperative 1 week and at postoperative 1 year to evaluate the left ventricular obstruction and the mitral regurgitation.
The left ventricular outflow tract gradient, left ventricular outflow tract velocity, septal thickness, and mitral regurgitation area decreased significantly at postoperative 1 week and 1 year in comparison with the baseline (all P < .001). The postoperative mitral regurgitation and systolic anterior motion of the mitral apparatus were completely abolished or significantly relieved. Only one patient had moderate mitral regurgitation of 7 cm2 after the surgery. At postoperative 1 year, all patients were asymptomatic, and the quality of life was significantly improved. The New York Heart Association (NYHA) class was I-II. Echocardiography showed good anatomy and function of the mitral valve.
Concomitant mitral valve abnormality is not uncommon in HOCM. Septal myectomy can adequately expand the left ventricular outflow tract and abolish mitral regurgitation and systolic anterior motion of the mitral apparatus. Concomitant mitral valvuloplasty is indicated for severe congenital abnormalities or secondary lesions of the mitral valve, and the outcomes are satisfactory.
我们试图分析肥厚型梗阻性心肌病（HOCM）合并二尖瓣异常的病理特征，并探讨手术治疗策略。
回顾性分析2014年1月至2016年3月治疗的26例HOCM患者的临床资料。其中男性19例，女性7例，平均年龄47±16岁（范围10 - 70岁）。超声心动图显示为HOCM、二尖瓣装置收缩期前向运动及合并二尖瓣反流。21例患者行扩大切除范围的改良Morrow手术。4例患者同时行二尖瓣成形术，1例患者行冠状动脉旁路移植术，1例患者行主动脉瓣置换术。术中、术后1周及术后1年行超声心动图检查，评估左心室梗阻及二尖瓣反流情况。
与基线相比，术后1周和1年时左心室流出道压差、左心室流出道速度、室间隔厚度及二尖瓣反流面积均显著降低（均P <.001）。术后二尖瓣反流及二尖瓣装置收缩期前向运动完全消失或明显减轻。术后仅1例患者二尖瓣反流面积为7 cm²，为中度反流。术后1年时，所有患者均无症状，生活质量显著改善。纽约心脏协会（NYHA）心功能分级为I - II级。超声心动图显示二尖瓣解剖结构及功能良好。
HOCM合并二尖瓣异常并不少见。室间隔心肌切除术可充分扩大左心室流出道，消除二尖瓣反流及二尖瓣装置收缩期前向运动。对于二尖瓣严重先天性异常或继发性病变，应行二尖瓣成形术，效果满意。
