Borer J S, Bacharach S L, Green M V, Kent K M, Rosing D R, Seides S F, Morrow A G, Epstein S E
Circulation. 1979 Aug;60(2 Pt 2):82-7. doi: 10.1161/01.cir.60.2.82.
Patients with idiopathic hypertrophic subaortic stenosis (IHSS) have supernormal left ventricular systolic function at rest. Septal myotomy/myectomy reduces outflow obstruction and symptoms. However, it has been proposed that operation causes myocardial damage, with consequent reduction in left ventricular function and potentially deleterious long-term consequences, despite relief of symptoms. To evaluate the effect of myotomy and mylectomy on left ventricular function, we employed noninvasive radionuclide cineangiography at rest and during maximal exercise in21 consecutive patients with IHSS, before and 6 months after operation. In 30 normal subjects, the ejection fraction (EF) was 57 +/- 2% at rest and 71 +/- 2% during exercise. Before operation in patients with IHSS, the EF was supernormal at rest (76 +/- 2%, p less than 0.001), and normal during exercise (71 +/- 3%, NS). All patients improved from NYHA functional class III-IV preoperatively to class I-II postoperatively; the maximal provocable gradient invariably diminished (average, 100 +/- , mm Hg preop, 33 +/- 9 mm Hg postop, p less than 0.001). Postoperatively, the EF at rest was 67 +/- 2%, still supernormal, but less than that noted preoperatively (p less than 0.001). During exercise, the EF was 66 +/- 4%, only mildly diminished (p less than 0.01) from that preoperatively. We conclude that muscle resection during myotomy and myectomy usually does not cause any important impairment of global left ventricular function at rest or during exercise stress.
特发性肥厚性主动脉瓣下狭窄（IHSS）患者静息时左心室收缩功能超常。室间隔肌切开术/肌切除术可减轻流出道梗阻并缓解症状。然而，有人提出手术会导致心肌损伤，进而使左心室功能下降，并可能产生有害的长期后果，尽管症状得到缓解。为了评估肌切开术和肌切除术对左心室功能的影响，我们对21例连续性IHSS患者在手术前和术后6个月进行了静息和最大运动时的无创放射性核素心血管造影。在30名正常受试者中，静息时射血分数（EF）为57±2%，运动时为71±2%。IHSS患者术前静息时EF超常（76±2%，p<0.001），运动时正常（71±3%，无显著性差异）。所有患者术前纽约心脏协会（NYHA）心功能分级为III-IV级，术后改善为I-II级；最大可诱发压差始终减小（术前平均为100± ，mmHg，术后为33±9 mmHg，p<0.001）。术后静息时EF为67±2%，仍超常，但低于术前水平（p<0.001）。运动时EF为66±4%，仅较术前轻度降低（p<0.01）。我们得出结论，肌切开术和肌切除术中的肌肉切除通常不会在静息或运动应激时导致左心室整体功能出现任何重要损害。
