Göl M K, Emir M, Keleş T, Küçüker S A, Birincioğlu C L, Karagöz Y H, Kural T, Taşdemir O, Göksel S, Bayazit K
Cardiovascular Surgery Clinic, Türkiye Yüksek Ihtisas Hospital, Ankara, Turkey.
Ann Thorac Surg. 1997 Sep;64(3):739-45. doi: 10.1016/s0003-4975(97)00633-4.
This study was performed to assess the functional capacity of the survivors of septal myectomy for the treatment of hypertrophic obstructive cardiomyopathy in long-term follow-up as assessed by dobutamine stress echocardiography.
Sixty-nine patients with hypertrophic obstructive cardiomyopathy underwent septal myectomy between 1975 and 1996. The mean age was 25.4 +/- 13.6 years (range, 6-58 years), and 10 of the patients were women. The early mortality was 4.3%. Hospital survivors (95.7%) were followed up for a mean of 43.8 +/- 28.7 months (range, 6-114 months).
The postoperative mean functional capacity of the group was 1.47 +/- 0.56. No late deaths were reported. Forty-nine patients (74.2%) were evaluated with standard echocardiographic techniques, and 29 (43.9%) patients underwent dobutamine stress echocardiography. There was a significant decrease in the thickness of the interventricular septum after surgery. The mean preoperative and postoperative septal thickness was 1.99 +/- 0.59 cm (range, 1.3-3.8 cm) and 1.55 +/- 0.41 cm (range, 0.96-2.8 cm), respectively (p < 0.004). The mean posterior wall thickness was significantly less than the preoperative value (p = 0.008) and the left ventricular end-diastolic diameter was slightly greater in the postoperative measurements, but the difference was not significant (p = 0.162). Postoperative left ventricular outflow systolic gradients were reduced significantly when compared with preoperative values (preoperative mean, 78.4 +/- 33.6 mm Hg, range, 50-212 mm Hg versus postoperative mean, 17.9 +/- 15.9 mm Hg: range, 0-40 mm Hg; p < 0.0001).
Septal myectomy for patients with hypertrophic obstructive cardiomyopathy is a safe procedure with excellent clinical and functional results in the long-term follow-up.
本研究旨在通过多巴酚丁胺负荷超声心动图评估肥厚性梗阻性心肌病患者行室间隔心肌切除术后长期随访的功能能力。
1975年至1996年间，69例肥厚性梗阻性心肌病患者接受了室间隔心肌切除术。平均年龄为25.4±13.6岁（范围6 - 58岁），其中10例为女性。早期死亡率为4.3%。医院幸存者（95.7%）平均随访43.8±28.7个月（范围6 - 114个月）。
该组术后平均功能能力为1.47±0.56。未报告晚期死亡病例。49例患者（74.2%）接受了标准超声心动图检查，29例患者（43.9%）接受了多巴酚丁胺负荷超声心动图检查。术后室间隔厚度显著降低。术前和术后室间隔平均厚度分别为1.99±0.59厘米（范围1.3 - 3.8厘米）和1.55±0.41厘米（范围0.96 - 2.8厘米）（p < 0.004）。后壁平均厚度显著低于术前值（p = 0.008），术后左心室舒张末期直径略大于术前测量值，但差异不显著（p = 0.162）。与术前值相比，术后左心室流出道收缩期梯度显著降低（术前平均值78.4±33.6毫米汞柱，范围50 - 212毫米汞柱；术后平均值17.9±15.9毫米汞柱，范围0 - 40毫米汞柱；p < 0.0001）。
对于肥厚性梗阻性心肌病患者，室间隔心肌切除术是一种安全的手术，在长期随访中具有优异的临床和功能效果。
