Lysenko A V, Salagaev G I, Lednev P V, Dzeranova A N, Belov Yu V
Petrovsky National Research Center of Surgery, Moscow, Russia.
Sechenov First Moscow State Medical University, Moscow, Russia.
Khirurgiia (Mosk). 2023(10):7-13. doi: 10.17116/hirurgia20231017.
To analyze the incidence and causes of mitral valve replacement in patients with obstructive hypertrophic cardiomyopathy (HCM).
There were 172 patients (98 women and 74 men) with obstructive HCM and severe mitral valve insufficiency between November 2017 and May 2023. All patients complained of chronic heart failure NYHA class III. Surgical correction of left ventricular outflow tract (LVOT) obstruction and mitral valve repair with elimination of systolic anterior motion were technically successful in 160 (93.0%) patients.
The need for mitral valve replacement was noted in 12 (7.0%) patients. Mean cardiopulmonary bypass time was 83.5±19.2 min (94; 127), aortic cross-clamping - 62.8±14.3 min (70; 102). In 5 cases, primary mitral valve replacement was scheduled due to obvious organic lesion of the mitral valve (tearing of chords, rheumatic lesion with leaflet restriction). In 7 patients, valve replacement was forced after ineffective primary septal myectomy (LVOT pressure gradient, severe mitral insufficiency).
Mitral valve replacement is an involuntary strategy after ineffective myectomy with severe mitral insufficiency and high LVOT pressure gradient.
分析梗阻性肥厚型心肌病（HCM）患者二尖瓣置换术的发生率及原因。
2017年11月至2023年5月期间，共有172例梗阻性HCM且伴有严重二尖瓣关闭不全的患者（98例女性，74例男性）。所有患者均主诉有纽约心脏病协会（NYHA）III级慢性心力衰竭。160例（93.0%）患者经手术成功纠正左心室流出道（LVOT）梗阻并修复二尖瓣，消除了收缩期前向运动。
12例（7.0%）患者需要进行二尖瓣置换术。平均体外循环时间为83.5±19.2分钟（94；127），主动脉阻断时间为62.8±14.3分钟（70；102）。5例患者因二尖瓣明显器质性病变（腱索撕裂、伴有瓣叶受限的风湿性病变）而计划进行一期二尖瓣置换术。7例患者在初次室间隔心肌切除术后无效（LVOT压力阶差、严重二尖瓣关闭不全）而被迫进行瓣膜置换术。
二尖瓣置换术是在心肌切除术无效且伴有严重二尖瓣关闭不全和高LVOT压力阶差后的无奈策略。
