Department of Anesthesia and Pain Management, 33540Toronto General Hospital, University of Toronto, Toronto, Canada.
Department of Anesthesiology, Hospital Clínic, 16493University of Barcelona, Barcelona, Spain.
Asian Cardiovasc Thorac Ann. 2022 Jan;30(1):35-42. doi: 10.1177/02184923211047126. Epub 2021 Sep 24.
With an estimated overall mortality of less than 1 percent per year, hypertrophic cardiomyopathy, is the most common genetic cardiomyopathy. Intraoperative transesophageal echocardiography is the standard of care for assessing patients with hypertrophic obstructive cardiomyopathy undergoing surgical septal myectomy, allowing surgical planning, intraoperative hemodynamic monitoring, and postprocedural assessment of the repair, including detection of immediate complications. At various phases during surgical septal myectomy, the changing hemodynamic conditions may lead to worsening or improvement in left ventricle outflow tract obstruction by change in preload or afterload, systolic anterior motion of the mitral valve, or sympathetic stimulation. These characteristics represent unique challenges in the management of these patients, requiring a comprehensive understanding of the management of all the conditions required to decrease the left ventricle outflow tract gradient avoiding obstruction, which include the maintenance of sinus rhythm, adequate rate avoiding tachycardia and bradycardia, and avoidance of systemic hypotension preserving preload and afterload, with adequate vasoactive agents. The aim of this review is to summarize the perioperative assessment and management of patients undergoing hypertrophic obstructive myopathy surgery.
肥厚型心肌病的总死亡率估计每年不到 1%，是最常见的遗传性心肌病。术中经食管超声心动图是评估接受外科室间隔心肌切除术的肥厚型梗阻性心肌病患者的标准护理，允许进行手术规划、术中血流动力学监测以及术后修复评估，包括检测即时并发症。在外科室间隔心肌切除术的各个阶段，由于前负荷或后负荷变化、二尖瓣收缩前运动或交感神经刺激导致左心室流出道梗阻的血流动力学条件可能会恶化或改善。这些特征代表了这些患者管理中的独特挑战，需要全面了解所有降低左心室流出道梯度以避免梗阻所需条件的管理，包括维持窦性节律、避免心动过速和心动过缓的适当心率、避免全身低血压以保持前负荷和后负荷，以及使用足够的血管活性药物。本综述的目的是总结接受肥厚型梗阻性心肌病手术患者的围手术期评估和管理。
