室间隔心肌切除术对梗阻性肥厚型心肌病患者舒张功能的影响。
Impact of septal myectomy on diastolic function in patients with obstructive hypertrophic cardiomyopathy.
作者信息
Yang Qiulan, Cui Hao, Zhu Changsheng, Hu Haibo, Lv Jianhua, Liu Yao, Zhang Yang, Schaff Hartzell V, Wang Shuiyun
机构信息
Department of Cardiovascular Surgery, Fuwai Hospital, National Center for Cardiovascular Diseases, Chinese Academy of Medical Sciences and Peking Union Medical College, Beijing, China.
Department of Cardiovascular Surgery, Mayo Clinic, Rochester, Minnesota, USA.
出版信息
J Thorac Dis. 2021 Aug;13(8):4925-4934. doi: 10.21037/jtd-21-902.
BACKGROUND
The impact of septal myectomy on diastolic function in patients with obstructive hypertrophic cardiomyopathy is not well studied.
METHODS
A transcatheter hemodynamic study was performed before and 3 to 6 months after septal myectomy in 12 patients with obstructive hypertrophic cardiomyopathy (HCM).
RESULTS
Postoperative hemodynamic studies were done 4.4±1.2 months after myectomy. The left ventricular outflow tract peak-to-peak gradient decreased from 83.2±43.3 mmHg preoperatively to 11.6±4.3 mmHg after myectomy (P<0.00). The left ventricular diastolic time constant (Tau) was 64.2±26.1 ms before surgery and 42.2±15.7 ms postoperatively (P=0.029). The average left atrial pressure (LAP) decreased from 20.2±7.0 to 12.1±4.5 mmHg after myectomy (P=0.008). Pulmonary artery hypertension was present in 6 patients preoperatively and remained in 2 patients after myectomy. Mean pulmonary artery pressure decreased from 29.3±16.2 to 20±6.7 mmHg after surgery (P=0.05), and the systolic pulmonary artery pressure decreased from 46±26.9 to 30.5±8.3 mmHg (P=0.048). Pulmonary vascular resistance decreased from 5.7±4.1 to 3.6±1.6 wood after surgery (P=0.032).
CONCLUSIONS
Septal myectomy improved left ventricular diastolic function and subsequently relieved the right ventricular congestion in patients with obstructive HCM.
背景
对于梗阻性肥厚型心肌病患者，室间隔心肌切除术对舒张功能的影响尚未得到充分研究。
方法
对12例梗阻性肥厚型心肌病（HCM）患者在室间隔心肌切除术前及术后3至6个月进行经导管血流动力学研究。
结果
心肌切除术后4.4±1.2个月进行了术后血流动力学研究。左心室流出道峰峰值压差从术前的83.2±43.3 mmHg降至术后的11.6±4.3 mmHg（P<0.00）。左心室舒张时间常数（Tau）术前为64.2±26.1 ms，术后为42.2±15.7 ms（P=0.029）。平均左心房压力（LAP）在心肌切除术后从20.2±7.0降至12.1±4.5 mmHg（P=0.008）。6例患者术前存在肺动脉高压，心肌切除术后仍有2例存在。术后平均肺动脉压力从29.3±16.2降至20±6.7 mmHg（P=0.05），收缩期肺动脉压力从46±26.9降至30.5±8.3 mmHg（P=0.048）。术后肺血管阻力从5.7±4.1降至3.6±1.6伍德（P=0.032）。
结论
室间隔心肌切除术改善了梗阻性HCM患者的左心室舒张功能，进而缓解了右心室充血。
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