摘要
目的总结分析改良Morrow手术治疗肥厚型梗阻性心肌病(HOCM)中远期随访的临床结果。方法 2003年3月至2014年12月,62例患者接受外科手术治疗肥厚型梗阻性心肌病,所有患者均行改良Morrow手术。患者的平均年龄为(39.6±15.1)岁,其中男性43例,女性19例。所有患者在全麻、中度低温体外循环下行扩大的室间隔心肌切除术(改良Morrow术),术中常规行经食管超声心动图(TEE)监测。患者术后每年随访并行超声心动图、心电图检查,通过对比术前、术中、术后一周及随访时TTE和心电图结果,评估左心室流出道梗阻解除效果及心律失常的发生。采用Kaplan-Meier生存曲线评估患者远期存活率。结果所有62例患者住院期间无死亡,均顺利出院,未发生严重并发症(室间隔穿孔、完全性房室传导阻滞等)。超声心动图结果显示术后左室流出道压差(LVOTG)下降幅度较大[(17.0±13.6)mm Hg vs(88.1±34.4)mm Hg;P=0.0000)],术后室间隔厚度较手术前有明显的变化[(12.8±4.1)mm vs(28.1±8.8)mm;P=0.000)]。术后二尖瓣前叶收缩期前向运动现象以及二尖瓣关闭不全的程度于术前比较明显减轻甚至消失。平均随访(67.5±47.2)个月(12~146个月),随访率96.7%(60/62)。随访发现1例死亡,原因不详,其中仅8例患者偶有轻度胸闷或头晕症状,其症状较轻未影响正常工作和生活,余52例患者无症状,全部患者的心功能均改善明显。术后1年、5年、10年的经胸超声(TTE)提示LVOTG等超声心动图指标与术后早期无明显差别。术后1年存活率100%,5年存活率97.6%,10年存活率97.6%。结论改良Morrow手术是治疗HOCM最有效的方法,可以彻底解除左心室流出道梗阻,无复发,患者症状明显改善或消失,心功能明显改善,远期存活率高。
Objective To assess the results of mid and long term clinical follow-up of extended septal myectomy（ modified Morrow procedure） for obstructive hypertrophic cardiomyopathy（ HOCM）.Methods From March 2003 to December 2014,a total of 62 patients（ 39.6± 15. 1 years; 43 males and 19 females） received extended septal myectomy under general anesthesia and standard cardiopulmonary bypass（ CPB） with moderate systemic temperature. Transesophageal echocardiography（ TEE） was performed to evaluate the effect of operation. TTE or TEE,and ECG of pre-operation,intraoperative,post-operation and follow-up visit were performed to assess the effect of left ventricular outflow tract obstruction（ LVOTO） at 1,5,10 years postoperatively. Kaplan-Meier curve was performed to assess the survival rate. Results All patients were discharged without severe complications（ iatrogenic ventricular septal defect or complete atrioventricular block）. TEE or TTE showed that the mean systolic gradient between the left ventricle and the aorta decreased from（ 88.1±34.4） mm Hg to（ 17.0±13.6） mm Hg（ P 0.0001）,and thickness of the ventricular septum reduced from（ 28.1±8.8） mm to（ 12.8±4.1） mm,（ P 0.0001）. Mitral regurgitation and SAM were significantly improved or disappeared. The average follow-up time was（ 67.5±47.2） months（ range,12-146 months） with the completeness of follow-up rate of 96.7% （ 60/62）. During the follow-up,one patient died from unknown reason. All other patients became completely asymptomatic or had mild dyspnea only. TTE showed that the pressure gradient was maintained at the post-operational level. Long-term survival rate was 100% ,97.6% ,97.6% at 1,5 and 10 years. Conclusion Extended septal myectomy with modified Morrow procedure was an effective method for patients with HOCM. The symptoms and the cardiac function of patients improved significantly after the surgery,and the long-term survival rate was good.
作者
刘帅
任崇雷
陈磊
王嵘
肖苍松
吴扬
王瑶
高长青
Liu Shuai;Ren Chonglei;Chen Lei;Wang Rong;Xiao Cangsong;Wu Yang;Wang Yao;Gao Changqing(Department of Cardiovascular Surgery, PLA General Hospital, Beijing , 100853, China)
出处
《中国体外循环杂志》
2018年第2期85-90,共6页
Chinese Journal of Extracorporeal Circulation
基金
解放军总医院临床科研苗圃基金项目(15KMM18)
