Wei P J, Liu J, Tan T, Zhu W, Zhuang J, Guo H M
Department of Cardiovascular Surgery, Guangdong Provincial People's Hospital, Guangdong Academy of Medical Sciences, Guangdong Cardiovascular Institute, Guangdong Provincial Key Laboratory of South China Structural Heart Disease, Guangzhou 510080, China.
Department of Adult Cardiac Ultrasound Medicine, Guangdong Provincial People's Hospital, Guangdong Academy of Medical Sciences, Guangdong Cardiovascular Institute, Guangzhou 510080, China.
Zhonghua Wai Ke Za Zhi. 2023 Mar 1;61(3):214-219. doi: 10.3760/cma.j.cn112139-20220918-00399.
To examine the early effect of thoracoscopic trans-mitral myectomy for hypertrophic cardiomyopathy patients with left midventricular obstruction. From April 2020 to July 2021, 10 hypertrophic cardiomyopathy patients with left midventricular obstruction underwent thoracoscopic trans-mitral myectomy at Guangdong Provincial People's Hospital. The whole group of patients consisted of 7 males and 3 females aged (52.0±16.4) years (range: 18 to 68 years). The EuroSCORE Ⅱ predicted mortality rate was 1.78% (1.20%) ((IQR)) (range: 0.96% to 4.86%). The clinical data were collected and analyzed retrospectively to evaluate the clinical efficacy by comparing preoperative and postoperative echocardiographic parameters using paired -test, paired Wilcoxon test or Fisher exact test, including left ventricular outflow tract peak pressure gradient, maximum interventricular septum thickness, systolic anterior motion of the anterior mitral leaflet and so on. The safety was determined by summarizing the incidence of perioperative and follow-up complications. All the procedures successed with no conversion to median sternotomy, septal defect, ventricular rupture. There was no in-hospital 30-day death, neither serious complications like permanent pacemaker implantation, re-sternotomy for bleeding, low cardiac output syndrome, stroke, or multiple organ dysfunction syndrome. The left ventricular outflow tract obstruction was effectively relieved in all patients expect a patient developed residual obstruction. Compared with that of pre-operation, the thickness of the interventricular septum was significantly reduced from (22.1±4.0) mm to (10.3±1.7) mm (=10.693, <0.01), while the left ventricular outflow tract peak pressure gradient was significantly reduced from (81.7±21.1) mmHg to 12.3 (11.5) mmHg (=-2.805, <0.01) (1 mmHg=0.133 kPa). Thoracoscopic trans-mitral myectomy is an effective and safe procedure for hypertrophic cardiomyopathy patients with left midventricular obstruction.
探讨胸腔镜经二尖瓣室间隔心肌切除术对左心室中段梗阻肥厚型心肌病患者的早期疗效。2020年4月至2021年7月，10例左心室中段梗阻肥厚型心肌病患者在广东省人民医院接受胸腔镜经二尖瓣室间隔心肌切除术。全组患者共7例男性和3例女性，年龄（52.0±16.4）岁（范围：18至68岁）。欧洲心脏手术风险评估系统（EuroSCORE）Ⅱ预测死亡率为1.78%（1.20%）（四分位间距）（范围：0.96%至4.86%）。回顾性收集并分析临床资料，通过配对t检验、配对Wilcoxon检验或Fisher确切检验比较术前和术后超声心动图参数来评估临床疗效，这些参数包括左心室流出道峰值压力阶差、最大室间隔厚度、二尖瓣前叶收缩期前向运动等。通过总结围手术期和随访并发症的发生率来确定安全性。所有手术均成功，无一例中转正中开胸、室间隔穿孔、心室破裂。无30天内院内死亡，也无永久性起搏器植入、再次开胸止血、低心排血量综合征、卒中或多器官功能障碍综合征等严重并发症。除1例患者出现残余梗阻外，所有患者的左心室流出道梗阻均得到有效缓解。与术前相比，室间隔厚度从（22.1±4.0）mm显著降至（10.3±1.7）mm（t=10.693，P<0.01），而左心室流出道峰值压力阶差从（81.7±21.1）mmHg显著降至12.3（11.5）mmHg（t=-2.805，P<0.01）（1mmHg = 0.133kPa）。胸腔镜经二尖瓣室间隔心肌切除术对左心室中段梗阻肥厚型心肌病患者是一种有效且安全的手术方法。
