Rahmouni Kenza, Issa Hugo M N, Toubar Omar, Crean Andrew M, Williams Anne, Nguyen Hanh, Ponnambalam Menaka, Grau Juan, Dickie Sean, Maharajh Gyaandeo, Ruel Marc
Division of Cardiac Surgery, Department of Surgery, University of Ottawa Heart Institute, University of Ottawa, Ottawa, Ontario, Canada.
Division of Cardiovascular Surgery, Department of Surgery, Children's Hospital of Eastern Ontario, Ottawa, Ontario, Canada.
CJC Open. 2025 Apr 19;7(7):851-859. doi: 10.1016/j.cjco.2025.04.007. eCollection 2025 Jul.
This study reports a single institution's clinical and echocardiographic outcomes for septal myectomy with vs without concomitant mitral valve interventions in patients with hypertrophic cardiomyopathy (HCM) and left ventricular outflow tract (LVOT) obstruction.
Consecutive patients who underwent transaortic septal myectomy with vs without subvalvular mitral apparatus intervention for HCM between October 2019 and March 2024 were included. All patients underwent transesophageal echocardiography and cardiac magnetic resonance imaging to confirm the pathology, measure intracavitary gradients, and assess mitral valve morphology. Patients were analyzed as an entire cohort and stratified by the presence of marked (> 15 mm) or only mild (≤ 15 mm) septal hypertrophy.
A total of 61 patients (32 male) were included, of whom 28 (45.9%) had mild septal hypertrophy. The follow-up assessment was 100% complete and averaged 26.9 ± 16.2 months. In addition to septal myectomy, 32 patients (52.5%) underwent concomitant papillary muscle realignment, and aberrant chordae were resected in 40 patients (65.6%). All patients with a septal thickness ≤ 15 mm had a mitral valve repair intervention. The 30-day and 2-year mortality were 1.6% and 3.3%, respectively. No postoperative ventricular septal defects occurred, including in the thin septum subgroup. Peak LVOT gradients were significantly reduced with surgery, both at rest (47.8 ± 34.7 mm Hg preoperatively vs 8.8 ± 12.3 mm Hg postoperatively, < 0.001) and under stress (114.2 ± 58.7 mm Hg preoperatively vs 17.6 ± 18.5 postoperatively, < 0.001).
In patients with symptomatic HCM, even in those without marked septal hypertrophy, septal myectomy with a concomitant mitral valve apparatus intervention is safe and provides excellent relief of LVOT obstruction.
本研究报告了一家机构中肥厚型心肌病（HCM）合并左心室流出道（LVOT）梗阻患者行与不行二尖瓣干预的间隔心肌切除术的临床和超声心动图结果。
纳入2019年10月至2024年3月期间因HCM行与不行瓣下二尖瓣装置干预的经主动脉间隔心肌切除术的连续患者。所有患者均接受经食管超声心动图和心脏磁共振成像，以确认病理、测量心腔内梯度并评估二尖瓣形态。将患者作为一个整体队列进行分析，并根据是否存在明显（>15mm）或仅轻度（≤15mm）间隔肥厚进行分层。
共纳入61例患者（32例男性），其中28例（45.9%）有轻度间隔肥厚。随访评估100%完成，平均随访时间为26.9±16.2个月。除间隔心肌切除外，32例患者（52.5%）同时接受了乳头肌重新排列，40例患者（65.6%）切除了异常腱索。所有间隔厚度≤15mm的患者均接受了二尖瓣修复干预。30天和2年死亡率分别为1.6%和3.3%。术后未发生室间隔缺损，包括薄间隔亚组。手术使LVOT峰值梯度显著降低，无论是静息时（术前47.8±34.7mmHg vs术后8.8±12.3mmHg，<0.001）还是应激状态下（术前114.2±58.7mmHg vs术后17.6±18.5mmHg，<0.001）。
对于有症状的HCM患者，即使是没有明显间隔肥厚的患者，行间隔心肌切除术并同时进行二尖瓣装置干预也是安全的，且能有效缓解LVOT梗阻。
