Department of Cardiovascular Surgery, Fuwai Hospital, National Center for Cardiovascular Diseases, National Clinical Research Center for Cardiovascular Diseases, Chinese Academy of Medical Sciences and Peking Union Medical College, Beijing, China.
Department of Cardiovascular Surgery, Fuwai Hospital, National Center for Cardiovascular Diseases, National Clinical Research Center for Cardiovascular Diseases, Chinese Academy of Medical Sciences and Peking Union Medical College, Beijing, China.
Heart Lung Circ. 2023 Sep;32(9):1122-1127. doi: 10.1016/j.hlc.2023.05.011. Epub 2023 Jun 23.
Left ventricular apical aneurysm (LVAA) is a rare complication of hypertrophic obstructive cardiomyopathy (HOCM). This study aimed to illustrate the clinical characteristics and surgical outcomes of these patients.
Patients with HOCM and LVAA who underwent modified extended Morrow myectomy and surgical left ventricular reconstruction (SLVR) between October 2012 and March 2021 were retrospectively recruited. Patients with coronary artery disease were excluded. Clinical characteristics were summarised. Time-to-event outcomes were calculated using the Kaplan-Meier method and compared by a log-rank test.
Fifteen eligible patients were identified; the mean age was 39.9±17.2 years and 40.0% of them were female. All patients had dyspnoea, 46.7% presented with syncope and/or chest pain, and 13.3% had a family history of hypertrophic cardiomyopathy. The mean LVAA size was 36.9±12.3 mm in length and 28.5±11.3 mm in width. Echocardiography showed LV outflow tract obstruction in seven (46.7%) patients, mid-cavity LV obstruction in 12 (80.0%), while systolic anterior motion (SAM) was seen in seven (46.7%). The symptoms were resolved in all patients postoperatively. During a median follow-up of 22.0 months, one (6.7%) patient had sudden cardiac death, one (6.7%) had a haemorrhagic stroke, and the LVAA recurrence was 40.0%. Subgroup analysis showed that signs of SAM and larger LVAA (≥30 mm) were associated with an increased tendency for a longer hospital stay.
Patients with HOCM and LVAA present with high-risk profiles. Modified extended Morrow myectomy combined with SLVR is useful in relieving the symptoms and improving the prognosis, although there might be recurrent LVAA.
左心室心尖部瘤（LVAA）是肥厚型梗阻性心肌病（HOCM）的罕见并发症。本研究旨在阐明此类患者的临床特征和手术结果。
回顾性招募 2012 年 10 月至 2021 年 3 月期间接受改良延伸型 Morrow 心肌切除术和外科左心室重建术（SLVR）的 HOCM 合并 LVAA 患者。排除患有冠状动脉疾病的患者。总结临床特征。使用 Kaplan-Meier 方法计算时间事件结局，并通过对数秩检验进行比较。
确定了 15 名符合条件的患者；平均年龄为 39.9±17.2 岁，其中 40.0%为女性。所有患者均有呼吸困难，46.7%出现晕厥和/或胸痛，13.3%有肥厚型心肌病家族史。LVAA 长度平均为 36.9±12.3mm，宽度为 28.5±11.3mm。超声心动图显示 7 名（46.7%）患者存在左心室流出道梗阻，12 名（80.0%）患者存在中段 LV 梗阻，7 名（46.7%）患者出现收缩期前向运动（SAM）。所有患者术后症状均得到缓解。在中位随访 22.0 个月期间，1 名（6.7%）患者发生心脏性猝死，1 名（6.7%）患者发生出血性卒中，LVAA 复发率为 40.0%。亚组分析显示，SAM 征象和更大的 LVAA（≥30mm）与更长的住院时间呈正相关。
HOCM 合并 LVAA 的患者具有高风险特征。改良延伸型 Morrow 心肌切除术联合 SLVR 可缓解症状并改善预后，尽管可能会出现 LVAA 复发。
