摘要
目的探讨经右胸微创切口采用改良扩大Morrow手术及"缘对缘"二尖瓣成形术治疗肥厚型梗阻性心肌病(HOCM)合并二尖瓣反流(MR)的疗效及安全性。方法2008年1月至2018年6月,我科经右胸微创切口采用改良扩大Morrow手术及"缘对缘"二尖瓣成形术治疗HOCM合并中度以上MR 54例,其中男31例、女23例,年龄(47.1±12.6)岁。患者术前均合并二尖瓣收缩期前向运动(SAM)现象。术前平均左心室流出道峰值压差(93.6±32.8)mm Hg,平均室间隔厚度(24.8±2.8)mm。结果全组患者均顺利完成手术。围术期无死亡病例,无转为胸部正中切口手术,无室间隔穿孔发生。1例(1.9%)患者因完全性房室传导阻滞安装心脏永久起搏器。出院前复查经胸超声心动图,平均左心室流出道峰值压差(18.1±6.2)mm Hg,平均室间隔厚度(14.5±2.1)mm,均较术前明显改善(P<0.05);二尖瓣关闭良好,无二尖瓣狭窄发生,无SAM现象。术后随访6~132个月,无死亡病例,无晚期永久起搏器植入,复查经胸超声心动图,平均左心室流出道峰值压差(19.4±5.7)mm Hg,平均室间隔厚度(14.2±1.5)mm,无SAM现象。结论经右胸微创切口采用改良扩大Morrow手术及"缘对缘"二尖瓣成形术治疗HOCM合并MR安全、有效,不仅可有效解除左心室流出道梗阻,而且可有效消除MR及SAM现象,早、中期治疗效果满意。
Objective To explore the effect and safety of surgical treatment for hypertrophic obstructive cardiomyopathy(HOCM)with mitral regurgitation(MR)through right mini-thoracotomy.Methods From January2008 to June 2018,54 patients with HOCM and moderate-to-severe MR underwent modified Morrow procedure and edge-to-edge mitral valvuloplasty through right mini-thoracotomy,including 31 males and 23 females,with an average age of 47.1±12.6 years.All patients had systolic anterior motion(SAM)phenomenon.Preoperative left ventricular outflow tract pressure gradient(LVOTPG)was 93.6±32.8 mm Hg,interventricular septum thickness(IVST)was 24.8±2.8 mm.Results Surgeries in all patients were completed successfully.No early death or interventricular septal perforation occurred.One(1.9%)patient received permanent pacemaker implantation due to the complete atrial-ventricular block.At discharge,postoperative LVOTPG(18.1±6.2 mm Hg)and IVST(14.5±2.1 mm)were significantly decreased compared with the preoperative values(P<0.05).No MR or SAM was observed in all patients.The follow-up time was 6-132 months,and during this period,no death,MR or SAM occurred.The average LVOTPG was 19.4±5.7 mm Hg,and the average IVST was 14.2±1.5 mm.Conclusion Morrow procedure and edge-to-edge mitral valvuloplasty through right minithoracotomy is a safe and effective method for treatment of HOCM with moderate-to-severe MR.
作者
姜兆磊
梅举
汤敏
刘浩
马南
沈赛娥
丁芳宝
黄健兵
JIANG Zhaolei;MEI Ju;TANG Min;LIU Hao;MA Nan;SHEN Sai’e;DING Fangbao;HUANG Jianbing(Department of Cardiothoracic Surgery,Xinhua Hospital,School of Medicine,Shanghai Jiao Tong University,Shanghai,200092,P.R.China;Department of Anesthesiology,Xinhua Hospital,School of Medicine,Shanghai Jiao Tong University,Shanghai,200092,P.R.China)
出处
《中国胸心血管外科临床杂志》
CAS
CSCD
2020年第7期754-757,共4页
Chinese Journal of Clinical Thoracic and Cardiovascular Surgery
基金
国家自然科学基金项目(81570290,81600264,81974023)
上海市科研计划项目(19411963800)
上海青年医师培养资助计划。
关键词
肥厚型梗阻性心肌病
二尖瓣反流
收缩期前向运动
“缘对缘”
Hypertrophic obstructive cardiomyopathy
mitral regurgitation
systolic anterior motion
edge-to-edge
