Department of Anesthesia and Pain Management, Toronto General Hospital, Toronto, ON, Canada.
Department of Anesthesia and Pain Management, Toronto General Hospital, Toronto, ON, Canada.
J Cardiothorac Vasc Anesth. 2021 Jun;35(6):1654-1662. doi: 10.1053/j.jvca.2020.12.014. Epub 2020 Dec 11.
Determine whether the intraoperative three-dimensional left ventricular outflow tract cross-sectional area may be inversely correlated with pressure gradients as a determinant of surgical success after septal myectomy in hypertrophic cardiomyopathy patients.
Perioperative data were obtained by retrospective review.
Toronto General Hospital, University of Toronto, Toronto, Canada, a tertiary hospital.
The study comprised 67 patients with hypertrophic obstructive cardiomyopathy.
Transthoracic and intraoperative transesophageal echocardiographic assessment of pressure gradients. Transesophageal measurement of the three-dimensional left ventricular outflow tract cross-sectional area.
The smallest left ventricular outflow tract area increased on average 1.883 cm (98.3%) after septal myectomy. There was a significant correlation between the increase in the area and the transesophageal pressure gradients (r = -0.32; p = 0.01) after myectomy, but none with postoperative transthoracic gradients at rest (r = -0.10; p = 0.42). Postoperative transesophageal and transthoracic gradients were significantly correlated (r = 0.26; p = 0.04). The best risk factors to predict high residual gradients were preoperative transesophageal gradient >97 mmHg, postoperative transesophageal area <3.16 cm, and moderate or more residual transesophageal mitral regurgitation (specificity 89%, 81%, and 78%, respectively).
Three-dimensional left ventricular outflow tract area measurements with transesophageal echocardiography after myectomy correlated fairly well with postoperative transesophageal pressure gradients. Patients with residual transthoracic elevated gradients after surgery at follow-up had a smaller transesophageal area and higher transesophageal pressure gradients immediately after the procedure. However, transesophageal pressure gradients after myectomy correlated poorly with follow-up transthoracic gradients at rest.
确定术中左心室流出道的三维横截面积是否与压力梯度呈负相关，从而作为肥厚型心肌病患者室间隔心肌切除术成功的决定因素。
通过回顾性研究获得围手术期数据。
多伦多总医院，多伦多大学，多伦多，加拿大，一家三级医院。
该研究包括 67 例肥厚型梗阻性心肌病患者。
经胸和术中经食管超声心动图评估压力梯度。经食管测量左心室流出道的三维横截面积。
室间隔心肌切除术后，平均左心室流出道面积增加 1.883cm（98.3%）。面积增加与经食管压力梯度之间存在显著相关性（r=-0.32；p=0.01），但与术后静息时经胸梯度无关（r=-0.10；p=0.42）。术后经食管和经胸梯度呈显著相关性（r=0.26；p=0.04）。预测残余梯度高的最佳危险因素是术前经食管梯度>97mmHg，术后经食管面积<3.16cm 和中度或更严重的残余经食管二尖瓣反流（特异性分别为 89%、81%和 78%）。
室间隔心肌切除术后经食管超声心动图测量的左心室流出道三维面积与术后经食管压力梯度相关性较好。术后随访时仍有较高经胸梯度的患者，其术后经食管面积较小，经食管压力梯度较高。然而，室间隔心肌切除术后的经食管压力梯度与静息时的经胸梯度相关性较差。
