Hong Joon Hwa, Nguyen Anita, Schaff Hartzell Vernon
Cardiovascular Surgery, Heart Research Institute, Chung-Ang University College of Medicine, Seoul, Republic of Korea.
Department of Cardiovascular Surgery, Mayo Clinic, 200 First Street SW, Rochester, MN 55905 USA.
Indian J Thorac Cardiovasc Surg. 2020 Jan;36(Suppl 1):34-43. doi: 10.1007/s12055-019-00817-y. Epub 2019 May 7.
Septal myectomy is the gold standard treatment option for patients with obstructive hypertrophic cardiomyopathy whose symptoms do not respond to medical therapy. This operation reliably relieves left ventricular outflow tract gradients, systolic anterior motion of the mitral valve, and associated mitral valve regurgitation. However, there remains controversy regarding the necessity of mitral valve intervention at the time of septal myectomy. While some clinicians advocate for concomitant mitral valve procedures, others strongly believe that the mitral valve should only be operated on if there is intrinsic mitral valve disease. At Mayo Clinic, we have performed septal myectomy on more than 3000 patients with obstructive hypertrophic cardiomyopathy, and in our experience, mitral valve operation is rarely necessary for patients who do not have intrinsic mitral valve disease such as leaflet prolapse or severe calcific stenosis. In this paper, we review anatomical considerations, imaging, and surgical approaches in the management of the mitral valve in hypertrophic cardiomyopathy.
对于药物治疗无效的梗阻性肥厚型心肌病患者，室间隔心肌切除术是金标准治疗方案。该手术能可靠地减轻左心室流出道压差、二尖瓣收缩期前向运动及相关的二尖瓣反流。然而，关于室间隔心肌切除术时二尖瓣干预的必要性仍存在争议。一些临床医生主张同期进行二尖瓣手术，而另一些人则坚信只有在存在原发性二尖瓣疾病时才应对二尖瓣进行手术。在梅奥诊所，我们已为3000多名梗阻性肥厚型心肌病患者实施了室间隔心肌切除术，根据我们的经验，对于没有原发性二尖瓣疾病（如瓣叶脱垂或严重钙化性狭窄）的患者，很少需要进行二尖瓣手术。在本文中，我们回顾了肥厚型心肌病二尖瓣处理中的解剖学考量、影像学及手术方法。
