Department of Cardiovascular Surgery, Sakakibara Heart Institute, Tokyo, Japan.
Cardiology, Sakakibara Heart Institute, Tokyo, Japan.
J Cardiothorac Surg. 2021 Dec 30;16(1):360. doi: 10.1186/s13019-021-01745-y.
Apical hypertrophic cardiomyopathy is a variant of hypertrophic cardiomyopathy that predominantly affects the apex of the left ventricle and rarely involves the right ventricular apex or both apexes. Heart transplantation is the traditional treatment for apical hypertrophic cardiomyopathy. Although surgical myectomy approaching the apex has been available for decades, its safety and accuracy greatly depend on the surgeon's skills and experience.
The first case involved a 63-year-old man with apical hypertrophic cardiomyopathy, wherein preoperative contrast computed tomography findings revealed apical hypertrophy and complete apical cavity obliteration. The patient underwent extended myectomy, which revealed the apex cavity filled with abnormal muscles. Using the transaortic approach, the location of the bilateral papillary muscle was confirmed, thereby providing the required orientation. The abnormal muscle mass was successfully resected, and the postoperative end-diastolic volume was extremely increased. The second case involved a 43-year-old man with an apical left ventricular aneurysm and mid-hypertrophic cardiomyopathy obstruction. The thin-walled apical aneurysm contained a large apical-basal band. Upon detecting the bilateral papillary muscle, mid-ventricular myectomy was performed from the apex. During postoperative catheterization, there was no pressure gradient between the left ventricle and aorta.
We reviewed two cases of apical hypertrophic cardiomyopathy, efficiently treated using extended apical myectomy. Although it is an uncommon procedure, the cases presented show how it can be used to successfully manage cases of apical hypertrophic cardiomyopathy. However, it is important to secure the postoperative left ventricular end-diastolic volume.
心尖肥厚型心肌病是肥厚型心肌病的一种变体，主要影响左心室心尖，很少累及右心室心尖或双心尖。心脏移植是心尖肥厚型心肌病的传统治疗方法。虽然向心尖部进行外科心肌切除术已有数十年的历史，但它的安全性和准确性在很大程度上取决于外科医生的技能和经验。
第一个病例是一位 63 岁的男性，患有心尖肥厚型心肌病，术前对比增强 CT 检查结果显示心尖部肥厚和完全心尖腔闭塞。患者接受了广泛的心肌切除术，发现心尖腔充满了异常的肌肉。通过经主动脉入路，确认了双侧乳头肌的位置，从而提供了所需的方向。异常的肌肉组织被成功切除，术后舒张末期容积显著增加。第二个病例是一位 43 岁的男性，患有左心室心尖部动脉瘤和中部肥厚型梗阻性心肌病。薄壁的心尖部动脉瘤内有一个大的心尖基底带。在发现双侧乳头肌后，从心尖部进行了中部心室心肌切除术。在术后导管插入术期间，左心室和主动脉之间没有压力梯度。
我们回顾了两例心尖肥厚型心肌病患者，采用广泛的心尖部心肌切除术进行了有效的治疗。虽然这是一种不常见的手术方法，但所介绍的病例表明，它可以成功地用于治疗心尖肥厚型心肌病。然而，确保术后左心室舒张末期容积是很重要的。
