Chen Yue, Quintana Eduard, Fang Jing, Liu Yani, Wei Xiang
Division of Cardiovascular Surgery, Tongji Hospital, Tongji Medical College, Huazhong University of Science and Technology, Wuhan 430030, China.
Key Laboratory of Organ Transplantation, Ministry of Education, NHC Key Laboratory of Organ Transplantation; Key Laboratory of Organ Transplantation, Chinese Academy of Medical Sciences, Wuhan, 430030, China.
Interdiscip Cardiovasc Thorac Surg. 2025 Sep 2;40(9). doi: 10.1093/icvts/ivaf195.
Anomalous papillary muscles (PMs) directly inserted into the anterior mitral valve (MV) constitute an infrequent anomaly in obstructive hypertrophic cardiomyopathy (HCM). This study sought to evaluate the efficacy and safety of a novel approach with transapical beating-heart septal myectomy to relieve obstruction while avoiding abnormal PM manipulation.
Among 439 patients with obstructive HCM from March 2023 to February 2024, 27 patients (6.2%) were diagnosed with anomalous PM directly inserted into the anterior mitral leaflet. Isolated myectomy without PMs intervention was performed in these patients with a transapical beating-heart septal myectomy approach.
The median age of patients was 54 (47-60) years. The abnormal PMs insertion into the body (type I/II) and only the free edge (type III) of anterior MV leaflet were 21 and 6 patients, respectively. There was no operative death, septal perforation, conversion to sternotomy, blood transfusion, and no patients with preoperative normal conduction required a pacemaker. The resting left ventricular outflow tract gradient decreased from 110 (70-121) mm Hg at baseline to 10 (8-21) mm Hg at 12 months. Reduction to a mitral regurgitation (MR) grade ≤ 1+ was achieved in 25 (92.6%) patients at 12 months. At follow-up, 25 (92.6%) patients returned to New York Heart Association (NYHA) class I.
In selected patients with sufficient septal thickness and no intrinsic MV pathology, transapical beating-heart septal myectomy may provide obstruction and MR relief without direct PMs intervention. This new approach without sternotomy or cardiopulmonary bypass increases the options for this infrequent condition.
NCT05332691.
异常乳头肌（PMs）直接插入二尖瓣前叶是梗阻性肥厚型心肌病（HCM）中一种罕见的异常情况。本研究旨在评估经心尖跳动心脏间隔心肌切除术这一新颖方法在缓解梗阻同时避免异常乳头肌操作的有效性和安全性。
在2023年3月至2024年2月期间的439例梗阻性HCM患者中，27例（6.2%）被诊断为异常乳头肌直接插入二尖瓣前叶。对这些患者采用经心尖跳动心脏间隔心肌切除术方法进行了单纯心肌切除术，未对乳头肌进行干预。
患者的中位年龄为54（47 - 60）岁。异常乳头肌插入二尖瓣前叶体部（I/II型）和仅插入游离缘（III型）的患者分别为21例和6例。无手术死亡、室间隔穿孔、转为胸骨切开术、输血情况，术前传导正常的患者均无需起搏器。静息左心室流出道压差从基线时的110（70 - 121）mmHg降至12个月时的10（8 - 21）mmHg。12个月时，25例（92.6%）患者的二尖瓣反流（MR）程度降至≤1+级。随访时，25例（92.6%）患者恢复至纽约心脏协会（NYHA）I级。
对于选定的、室间隔厚度足够且无内在二尖瓣病变患者，经心尖跳动心脏间隔心肌切除术可能无需直接干预乳头肌即可缓解梗阻和二尖瓣反流。这种无需胸骨切开术或体外循环的新方法增加了针对这种罕见情况的治疗选择。
NCT05332691。
