Haering J M, Comunale M E, Parker R A, Lowenstein E, Douglas P S, Krumholz H M, Manning W J
Department of Anesthesia and Critical Care, Beth Israel Hospital, Boston, Massachusetts 02215, USA.
Anesthesiology. 1996 Aug;85(2):254-9. doi: 10.1097/00000542-199608000-00005.
Many data are available regarding cardiac risk in patients with coronary artery disease undergoing noncardiac surgery, but few data are available regarding risk for patients with hypertrophic cardiomyopathy and asymmetric septal hypertrophy.
Seventy-seven patients with asymmetric septal hypertrophy were identified in whom an echocardiogram had been performed within 24 months of noncardiac surgery. Patients' charts were reviewed for data regarding surgical operations, including length of surgery, type of anesthesia, and intravascular monitoring used. Data regarding adverse perioperative cardiac events also were gathered.
Forty percent (n = 31) of patients had one or more adverse perioperative cardiac events, including one patient who had a myocardial infarction and ventricular tachycardia that required emergent cardioversion. There were no perioperative deaths. All 31 patients had minor outcomes. Of the 77 patients, perioperative congestive heart failure developed in 12 (16%). Factors associated with adverse cardiac events were increasing length of surgical time (P < 0.01) major surgery (P < 0.05), and intensity of monitoring (P < 0.05). Age, gender, resting outflow tract gradient, systolic anterior motion of the anterior mitral leaflet, prior myocardial infarction, severity of mitral regurgitation, type of anesthetic, septal thickness, and the interval between echocardiogram and surgery were not associated with the occurrence of adverse cardiac events.
Patients with asymmetric septal hypertrophy undergoing noncardiac surgery have a high incidence of adverse cardiac events, frequently manifested as congestive heart failure. However, irreversible cardiac morbidity and mortality was extremely low. Important independent risk factors for adverse outcome in all patients include major surgery and increasing duration of surgery.
关于接受非心脏手术的冠心病患者的心脏风险已有许多数据，但关于肥厚型心肌病和不对称性室间隔肥厚患者的风险数据却很少。
在77例不对称性室间隔肥厚患者中，这些患者在非心脏手术的24个月内进行了超声心动图检查。回顾患者病历以获取有关手术操作的数据，包括手术时长、麻醉类型和使用的血管内监测。还收集了围手术期不良心脏事件的数据。
40%（n = 31）的患者发生了一项或多项围手术期不良心脏事件，包括1例发生心肌梗死和室性心动过速，需要紧急心脏复律的患者。没有围手术期死亡病例。所有31例患者的结局均较轻。在77例患者中，12例（16%）发生了围手术期充血性心力衰竭。与不良心脏事件相关的因素包括手术时间延长（P < 0.01）、大手术（P < 0.05）和监测强度（P < 0.05）。年龄、性别、静息流出道梯度、二尖瓣前叶收缩期前向运动、既往心肌梗死、二尖瓣反流严重程度、麻醉类型、室间隔厚度以及超声心动图与手术之间的间隔时间与不良心脏事件的发生无关。
接受非心脏手术的不对称性室间隔肥厚患者不良心脏事件发生率较高，常表现为充血性心力衰竭。然而，不可逆的心脏发病率和死亡率极低。所有患者不良结局的重要独立危险因素包括大手术和手术时间延长。
