El Mathari Sulayman, van Ooij Pim, Merton Renske, Schrauben Eric, Hopman Luuk, Nederveen Aart, Götte Marco, Kluin Jolanda
Department of Cardiothoracic Surgery, Amsterdam University Medical Center, Amsterdam, The Netherlands.
Department of Cardiothoracic Surgery, Erasmus University Medical Center, Rotterdam, The Netherlands.
Interdiscip Cardiovasc Thorac Surg. 2024 Dec 25;40(1). doi: 10.1093/icvts/ivae210.
The common surgical treatment in patients with obstructive hypertrophic cardiomyopathy is septal myectomy. This involves resection of a segment of the myocardial septum and can be performed with and without concomitant anterior mitral valve leaflet extension (AMVLE). While both approaches have satisfying clinical outcomes, there is a lack of data regarding the added value of concomitant AMVLE. In particular, their impact on postoperative haemodynamics remains unexplored. Therefore, we conducted a study to assess the feasibility of utilizing four-dimensional-flow cardiac magnetic resonance imaging (4D-flow cardiac magnetic resonance imaging (CMR)) to investigate postoperative haemodynamic differences among both surgical approaches.
In this feasibility study, nine subjects underwent 4D-flow CMR evaluation, including three patients who underwent isolated myectomy, three patients with myectomy + AMVLE and three healthy controls. Primary end-points were aortic wall shear stress, left ventricular outflow tract (LVOT) peak velocity and peak kinetic energy in the LVOT and ascending aorta.
Results showed that patients who underwent myectomy with concomitant AMVLE exhibited (i) lower aortic wall shear stress (-21.2%), (ii) lower LVOT peak velocity (-6.3%), (iii) higher kinetic energy in the LVOT (+10.8%) and (iv) lower kinetic energy in the ascending aorta (-28.8%) compared to patients who underwent isolated myectomy.
Patients undergoing additional AMVLE exhibited a better trend towards the haemodynamic reference values from healthy controls compared to patients undergoing isolated myectomy. Our findings underscore the feasibility of 4D-flow CMR to assess postoperative haemodynamic differences in hypertrophic cardiomyopathy patients undergoing different surgical approaches. This highlights the potential of 4D-flow CMR to compare surgical strategies based on postoperative haemodynamics.
Dutch National Medical Ethics Committee, registration number 2022.0078.
梗阻性肥厚型心肌病患者常见的外科治疗方法是室间隔心肌切除术。这包括切除一段心肌间隔，可在伴有或不伴有二尖瓣前叶延长（AMVLE）的情况下进行。虽然两种方法都有令人满意的临床结果，但关于AMVLE的附加价值的数据却很缺乏。特别是，它们对术后血流动力学的影响仍未得到探索。因此，我们进行了一项研究，以评估利用四维血流心脏磁共振成像（4D-血流心脏磁共振成像（CMR））来研究两种手术方法术后血流动力学差异的可行性。
在这项可行性研究中，9名受试者接受了4D-血流CMR评估，其中包括3名接受单纯心肌切除术的患者、3名接受心肌切除术+AMVLE的患者和3名健康对照者。主要终点是主动脉壁剪切应力、左心室流出道（LVOT）峰值速度以及LVOT和升主动脉中的峰值动能。
结果显示，与接受单纯心肌切除术的患者相比，接受心肌切除术并伴有AMVLE的患者表现出：（i）主动脉壁剪切应力降低（-21.2%），（ii）LVOT峰值速度降低（-6.3%），（iii）LVOT中的动能增加（+10.8%），以及（iv）升主动脉中的动能降低（-28.8%）。
与接受单纯心肌切除术的患者相比，接受额外AMVLE的患者在血流动力学参考值方面呈现出更接近健康对照者的趋势。我们的研究结果强调了4D-血流CMR评估肥厚型心肌病患者不同手术方法术后血流动力学差异的可行性。这突出了4D-血流CMR根据术后血流动力学比较手术策略的潜力。
荷兰国家医学伦理委员会，注册号2022.0078。
