Moreno Garijo Jacobo, Gadotti Giovanni, Amador Yannis, Fan Chun-Po Steve, Silverton Natalie, Ralph-Edwards Anthony, Meineri Massimiliano
Department of Anesthesia and Pain Management, Sunnybrook Health Sciences Centre, Toronto, Ontario, Canada.
Department of Anesthesia and Pain Management, Toronto General Hospital, Toronto, Ontario, Canada.
Ann Thorac Surg Short Rep. 2023 Oct 27;2(1):136-140. doi: 10.1016/j.atssr.2023.09.016. eCollection 2024 Mar.
This study explored the correlation between the 3-dimensional aorto-mitral angle and pressure gradients in patients with obstructive hypertrophic cardiomyopathy (HCM) undergoing septal myectomy, with or without aortic shortening.
A single-site, retrospective observational study was conducted at a tertiary-level hospital; 67 patients underwent septal myectomy for obstructive HCM. Preoperative and postoperative transesophageal images were analyzed offline to measure the end-systolic 3-dimensional aorto-mitral angle with Mitral Valve Quantification software and Doppler-derived pressure gradients. The angle's impact on pressure gradients after myectomy, with or without aortic shortening, was evaluated by linear regression.
Regression analysis found no significant relationship between aorto-mitral angle changes and postmyectomy pressure gradients ( = 0.03; 95% CI, -0.22 to 0.28; = .81), regardless of aortic shortening. No major angle differences were observed between myectomy-only patients and those with additional aortic shortening (97.0° ± 8.4° vs 100.4° ± 8.7°; = .78).
The reduced angle seen in patients with obstructive HCM did not return to normal values after septal myectomy, even with normalized pressure gradients. Aortic shortening did not significantly influence the aorto-mitral angle after myectomy either.
本研究探讨了接受室间隔心肌切除术的梗阻性肥厚型心肌病（HCM）患者的三维主动脉-二尖瓣角度与压力阶差之间的相关性，无论是否存在主动脉缩短。
在一家三级医院进行了一项单中心回顾性观察研究；67例患者因梗阻性HCM接受了室间隔心肌切除术。对术前和术后的经食管图像进行离线分析，使用二尖瓣定量软件测量收缩末期三维主动脉-二尖瓣角度以及多普勒衍生的压力阶差。通过线性回归评估该角度对心肌切除术后压力阶差的影响，无论是否存在主动脉缩短。
回归分析发现，无论是否存在主动脉缩短，主动脉-二尖瓣角度变化与心肌切除术后压力阶差之间均无显著关系（β = 0.03；95%CI，-0.22至0.28；P = 0.81）。单纯接受心肌切除术的患者与同时进行主动脉缩短术的患者之间未观察到角度的显著差异（97.0°±8.4°对100.4°±8.7°；P = 0.78）。
梗阻性HCM患者中观察到的角度减小在室间隔心肌切除术后并未恢复到正常值，即使压力阶差已恢复正常。主动脉缩短术对心肌切除术后的主动脉-二尖瓣角度也没有显著影响。
