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肥厚型梗阻性心肌病的外科治疗：除室间隔心肌切除之外的左心室流出道综合管理

Surgery for Hypertrophic Obstructive Cardiomyopathy: Comprehensive LVOT Management beyond Septal Myectomy.

作者信息

Affronti Alessandro, Pruna-Guillen Robert, Sandoval Elena, Pereda Daniel, Alcocer Jorge, Castellà Manuel, Quintana Eduard

机构信息

Cardiovascular Surgery, Institut Clínic Cardiovascular, Hospital Clínic de Barcelona, University of Barcelona Medical School, c/Villarroel 170 Esc 1 5th Floor, 08036 Barcelona, Spain.

出版信息

J Clin Med. 2021 Sep 26;10(19):4397. doi: 10.3390/jcm10194397.

DOI:10.3390/jcm10194397
PMID:34640415
原文链接:https://pmc.ncbi.nlm.nih.gov/articles/PMC8509570/
Abstract

Hypertrophic cardiomyopathy (HCM) is a complex, underestimated, multifaceted disease frequently associated with left ventricular outflow tract (LVOT) obstruction. It is clearly demonstrated that this is due not only to septal hypertrophy but also to systolic anterior motion (SAM) of mitral valve leaflets secondary to mitral valve/subvalvular apparatus abnormalities. Surgical treatment involves performing an extended septal myectomy, eventually followed by ancillary procedures to those structures responsible for maintaining LVOT obstruction, if necessary. In this review, we describe the spectrum of possible surgical techniques beyond septal myectomy and their pathophysiologic rationale.

摘要

肥厚型心肌病（HCM）是一种复杂、易被低估且多方面的疾病，常与左心室流出道（LVOT）梗阻相关。已明确表明，这不仅归因于室间隔肥厚，还归因于二尖瓣叶继发于二尖瓣/瓣下装置异常的收缩期前向运动（SAM）。手术治疗包括进行扩大的室间隔心肌切除术，如果有必要，最终对那些导致LVOT梗阻的结构进行辅助手术。在本综述中，我们描述了除室间隔心肌切除术之外可能的手术技术范围及其病理生理原理。

https://cdn.ncbi.nlm.nih.gov/pmc/blobs/28af/8509570/4575754854bb/jcm-10-04397-g005.jpg
https://cdn.ncbi.nlm.nih.gov/pmc/blobs/28af/8509570/f8b264e81034/jcm-10-04397-g001.jpg
https://cdn.ncbi.nlm.nih.gov/pmc/blobs/28af/8509570/712e443c3664/jcm-10-04397-g002.jpg
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https://cdn.ncbi.nlm.nih.gov/pmc/blobs/28af/8509570/9cbfeed7bcf5/jcm-10-04397-g004.jpg
https://cdn.ncbi.nlm.nih.gov/pmc/blobs/28af/8509570/4575754854bb/jcm-10-04397-g005.jpg
https://cdn.ncbi.nlm.nih.gov/pmc/blobs/28af/8509570/f8b264e81034/jcm-10-04397-g001.jpg
https://cdn.ncbi.nlm.nih.gov/pmc/blobs/28af/8509570/712e443c3664/jcm-10-04397-g002.jpg
https://cdn.ncbi.nlm.nih.gov/pmc/blobs/28af/8509570/1fb652a483bb/jcm-10-04397-g003.jpg
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https://cdn.ncbi.nlm.nih.gov/pmc/blobs/28af/8509570/4575754854bb/jcm-10-04397-g005.jpg

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The Mitral Valve in Hypertrophic Cardiomyopathy: Other Side of the Outflow Tract.肥厚型心肌病中的二尖瓣：流出道的另一面
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