Clinic of Cardiovascular Surgery, University of Health Sciences, Kartal Kosuyolu Heart Research Center, Istanbul, Turkey.
Clinic of Cardiovascular Surgery, Bagcılar Research and Training Hospital, Istanbul, Turkey.
Gen Thorac Cardiovasc Surg. 2020 Sep;68(9):962-968. doi: 10.1007/s11748-020-01306-5. Epub 2020 Feb 10.
Septal myectomy is the most effective treatment modality for hypertrophic obstructive cardiomyopathy. A retrospective study was conducted to evaluate outcomes of surgical myectomy alone or with concomitant mitral valve procedures.
From December 2011 through December 2016, a total of 41 patients with symptomatic hypertrophic obstructive cardiomyopathy were operated. There were 14 females and 27 males, aged between 18 and 73 years (mean 49.8 years). All patients had drug refractory symptoms (dyspnea, palpitation, chest pain, fainting, limitation of daily physical activities). Twenty-one patients received septal myectomy alone, 10 patients had SM with mitral valve repair and 10 patients had SM with mitral valve replacement. The average follow-up was 38.45 ± 12.18 months.
Surgery led to symptomatic improvement in all patients. None of the patients were left with NYHA Class III and IV symptoms after surgery. The improvement in left ventricular outflow tract gradient was from 116.65 mmHg preoperatively to 22.47 mmHg. Mean septal thickness decreased from 2.35 to 1.74 cm. Post procedure permanent pacemaker implantation was required for one patient due to complete heart block, and 2 intracardiac devices were implanted due to resistant arrthymia. None of the patients required a repeat procedure during follow-up period. Operative mortality was 2.4%.
Septal myectomy is safe and effective. Concomitant mitral operations do not increase morbidity and mortality.
室间隔心肌切除术是肥厚型梗阻性心肌病的最有效治疗方法。本回顾性研究旨在评估单纯手术心肌切除术或联合二尖瓣手术的治疗效果。
2011 年 12 月至 2016 年 12 月，共有 41 例有症状的肥厚型梗阻性心肌病患者接受了手术治疗。其中女性 14 例，男性 27 例，年龄 18 至 73 岁（平均 49.8 岁）。所有患者均有药物难治性症状（呼吸困难、心悸、胸痛、晕厥、日常体力活动受限）。21 例患者接受单纯室间隔心肌切除术，10 例患者接受室间隔心肌切除术联合二尖瓣修复术，10 例患者接受室间隔心肌切除术联合二尖瓣置换术。平均随访 38.45±12.18 个月。
所有患者的症状均得到改善。术后无患者仍存在纽约心脏协会（NYHA）心功能分级 III 级和 IV 级症状。左心室流出道梯度从术前的 116.65mmHg 降至术后的 22.47mmHg。室间隔厚度平均值从 2.35cm 降至 1.74cm。由于完全性心脏阻滞，术后需为 1 例患者植入永久性起搏器，由于难治性心律失常，植入 2 个心脏内装置。随访期间无患者需要再次手术。手术死亡率为 2.4%。
室间隔心肌切除术安全有效。联合二尖瓣手术不会增加发病率和死亡率。
