«上一篇/Previous Article|本期目录/Table of Contents|下一篇/Next Article»

《国际心血管病杂志》[ISSN:1006-6977/CN:61-1281/TN]

期数:

2020年02期

页码:

109-112

栏目:

临床研究

出版日期:

2020-03-29

文章信息/Info

Title:

Effects of classic Morrow procedure on 30 patients with hypertrophic obstructive cardiomyopathy

作者:

张韶鹏 付博 陈彤云 陈庆良 姜楠

300070 天津市胸科医院心外科,天津市心血管病研究所

Author(s):

ZHANG Shaopeng;  FU Bo;  CHEN Tongyun;  CHEN Qingliang;  JIANG Nan

Department of Cardiac Surgery, Tianjin Chest Hospital, Tianjin Institute of Cardiovascular Disease, Tianjin 300070, China

关键词:

流出道梗阻;  心肌病;  肥厚梗阻型;  Morrow 手术

Keywords:

Ventricular outflow obstruction;  Cardiomyopathy;  Hypertrophic;  Morrow procedure

分类号:

-

DOI:

10.3969/j.issn.1673-6583.2020.02.011

文献标识码:

-

摘要:

目的:观察经典Morrow手术治疗肥厚型梗阻性心肌病(HOCM)患者的临床效果。方法:纳入2011年12月—2018年1月在天津市胸科医院行经典Morrow手术治疗的30例肥厚型梗阻性心肌病患者,平均年龄(56.5±8.6)岁。比较手术前、术后早期和随访期经胸超声心动图结果,评价手术效果。术后平均随访(23±9)个月。结果:全组患者左室流出道压差(LVOTPG)从术前(91.39±38.38)mmHg下降至(15.48±14.12)mmHg(P<0.001),二尖瓣反流明显改善(P<0.001)。术后3 例患者因三度房室传导阻滞安装永久起搏器,无室间隔穿孔、瓣膜损伤等严重并发症的发生。18例接受二尖瓣置换术的患者LVOTPG下降至(10.30±8.41)mmHg(P<0.001),流出道梗阻改善更为满意,无不良事件发生。1例患者术后早期死于脑卒中,3例患者失访。随访26例患者,LVOTPG降至(6.41±7.25)mmHg,较术前明显改善。结论:经典Morrow手术可有效解除左室流出道梗阻,近中期效果满意。

Abstract:

Objective:To investigate the efficacy of classic Morrow procedure in patients with hypertrophic Obstructive cardiomyopathy(HOCM).Methods:Thirty HOCM patients who received classic Morrow procedure in Tianjin Chest hospital from December 2011 to January 2018 were retrospectively recruited, including 12(40%)males. The age was(56.5±8.6)years. The preoperative, postoperative and follow-up data of transthoracic echocardiography were compared to assess the effects of the surgery. The follow-up was(23±9)months.Results:Left ventricular outflow tract pressure gradient(LVOTPG)decreased from(91.39±38.38)mmHg to(15.48±14.12)mmHg after operation(P<0.001), and the mitral regurgitation was obviously improved(P<0.001). The majority of patients discharged without serious complications, such as ventricular septal perforation and valve damage, except for three patients who had the permanent pacemaker installation for complete atrioventricular block. LVOTPG in 18 patients undergoing mitral valve replacement(MVR), decreased to(10.30±8.41)mmHg(P<0.001), and the improvement of outflow tract obstruction was more satisfactory without adverse events. One patient died of cerebrovascular accident four days after the surgery, and three lost to follow-up. During the follow-up of 26 patients, LVOTPG decreased to(6.41±7.25)mmHg, which was significantly improved compared with the preoperative one.Conclusions:Classic Morrow surgery can effectively release the left ventricular outflow obstruction with a satisfactory outcome during the early and mid-term follow-up.

参考文献/References

[ 1 ] Zou Y, Song L, Wang Z, et al. Prevalence of idiopathic hypertrophic cardiomyopathy in China: a population-based echocardiographic analysis of 8080 adults[J]. Am J Med, 2004, 116(1):14-18.
[ 2 ] Wang S, Luo M, Sun H, et al. A retrospective clinical study of transaortic extended septal myectomy for obstructive hypertrophic cardiomyopathy in China[J]. Eur J Cardiothorac Surg, 2013, 43(3):534-540.
[ 3 ] Yao L, Li L, Lu XJ, et al. Long-term clinical and echocardiographic outcomes of extensive septal myectomy for hypertrophic obstructive cardiomyopathy in Chinese patients[J]. Cardiovasc Ultrasound, 2016, 14(1):18.
[ 4 ] Shimahara Y, Fujita T, Kobayashi J, et al. Combined mechanical mitral valve replacement and transmitral myectomy for hypertrophic obstructive cardiomyopathy treatment: An experience of over 20 years[J]. J Cardiol, 2019, 73(4):318-325.
[ 5 ] Morrow AG, Reitz BA, Epstein SE, et al. Operative treatment in hypertrophic subaortic stenosis. Techniques, and the results of pre and postoperative assessments in 83 patients[J]. Circulation, 1975, 52(1):88-102.
[ 6 ] Elliott PM, Anastasakis A, Borger MA, et al. 2014 ESC Guidelines on diagnosis and management of hypertrophic cardiomyopathy: the Task Force for the Diagnosis and Management of Hypertrophic Cardiomyopathy of the European Society of Cardiology(ESC)[J]. Eur Heart J, 2014, 35(39):2733-2779.
[ 7 ] Desai MY, Bhonsale A, Smedira NG, et al. Predictors of long-term outcomes in symptomatic hypertrophic obstructive cardiomyopathy patients undergoing surgical relief of left ventricular outflow tract obstruction[J]. Circulation, 2013, 128(3):209-216.
[ 8 ] Wang S, Cui H, Yu Q, et al. Excision of anomalous muscle bundles as an important addition to extended septal myectomy for treatment of left ventricular outflow tract obstruction[J]. J Thorac Cardiovasc Surg, 2016, 152(2):461-468.
[ 9 ] Vriesendorp PA, Schinkel AF, Soliman OI, et al. Long-term benefit of myectomy and anterior mitral leaflet extension in obstructive hypertrophic cardiomyopathy[J]. Am J Cardiol, 2015, 115(5):670-675.
[10] Sherrid MV, Balaram S, Kim B, et al. The mitral valve in obstructive hypertrophic cardiomyopathy: a test in context[J]. J Am Coll Cardiol, 2016, 67(15):1846-1858.
[11] 罗明尧, 王水云, 孙宏涛, 等. 肥厚型梗阻性心肌病外科治疗术后并发完全性房室传导阻滞的探讨[J].中华心血管病杂志, 2013, 41(7):598-601.
[12] 宋云虎. Morrow手术治疗肥厚型梗阻性心肌病719例疗效分析[J].中国循环杂志, 2015, 30(z1):86.
[13] Gersh BJ, Maron BJ, Bonow RO, et al. 2011 ACCF/AHA guideline for the diagnosis and treatment of hypertrophic cardiomyopathy: executive summary: a report of the American College of Cardiology Foundation/American Heart Association Task Force on Practice Guidelines[J]. J Am Coll Cardiol, 2011, 58(25):2703-2738.
[14] 王水云, 崔彬, 孙寒松, 等. 肥厚梗阻性心肌病的外科治疗[J].中华医学杂志, 2009, 89(39):2776-2778.
[15] Kwon DH, Smedira NG, Thamilarasan M, et al. Characteristics and surgical outcomes of symptomatic patients with hypertrophic cardiomyopathy with abnormal papillary muscle morphology undergoing papillary muscle reorientation[J]. J Thorac Cardiovasc Surg, 2010, 140(2):317-324.
[16] 康凯, 蔡俊, 贾智博, 等. 肥厚型梗阻性心肌病患者二尖瓣病变的外科治疗[J].中国胸心血管外科临床杂志,2016,23(8):765-768.
[17] Sherrid MV, Chaudhry FA, Swistel DG. Obstructive hypertrophic cardiomyopathy: echocardiography, pathophysiology, and the continuing evolution of surgery for obstruction[J]. Ann Thorac Surg, 2003, 75(2):620-632.
[18] Matsushiro T, Fujimatsu T, Miyaji K. Isolated mitral valve replacement was effective in patient with hypertrophic obstructive cardiomyopathy and concomitant mitral regurgitation; report of a case[J]. Kyobu Geka, 2019, 72(2):149-152.

备注/Memo

备注/Memo:

基金项目:天津市科技计划项目(18ZXDBSY00160,16ZXMJSY00160)
作者单位:300070 天津市胸科医院心外科,天津市心血管病研究所
通信作者:姜楠,E-mail:jiangnantj@126.com

常用功能

更新日期/Last Update: 2020-03-30